If you are interested in participating in the Job Location and Development Program, please use the following form below.  Providing as much information as possible below will help us in determining if you are eligible to be in the program.  Please note that space may be limited due to case loads.  A JLDP representative will reply within three working days.

TODAY'S DATE:

First Name: Last Name: Student ID:

Address: City: Zip:

Email Address: Phone:

Best way to contact you:

Phone  Mail E-mail 

TYPE OF STUDENT:

Type  1st Semester Continuing Student  MSJC Graduate 

Major:

What type of employment are you seeking?

What days/hours can you work?

Are you looking for:  Part-time  Full-time 

Are you currently employed?Yes No

How did you hear about us? (Check all that apply)

        Class Schedule 

        Online Campus Announcements  

        Campus Flyer  

        Eagle Access Center  

        Counselor  

        Other

Campus:

Menifee Valley Campus  San Jacinto Campus