Workforce Investment Opportunity Act - Pre Application

  • WorkSource Rogue Valley is a local organization that provides assistance with employment services and short-term training to the public through federal funding.

    We assist qualified youth, adults, and laid off workers with short-term education, training, and/or employment that will lead to long-term self-sufficiency.

    How to Apply:

    Turn in a completed pre-application to schedule the next step. The general eligibility requirements are based on household income for the past six months OR length and/or reason for unemployment.

    Applicants must also be:

    1. A United States Citizen or eligible to work in the United States;

    2. Able to provide verification of age and social security number; and

    3. Ready to go to work

    If you have any questions or need help, please call (541) 776-5100 in Medford or (541) 476-1187 in Grants Pass. We are looking forward to working with you.

    WorkSource Rogue Valley is an equal opportunity employer and operates equal opportunity programs. Auxiliary aids and services are available upon request to individuals with disabilities.

    State and Federal law protects the privacy of your records. The Workforce Innovation Opportunity Act (WIOA) is a federal law that creates a One-Stop system for training and employment services. By combining employment and training services at one site, you receive better service.

    State rules (OAR 151-020-0065) authorize WorkSource Rogue Valley (a WIOA Title 1B provider) to request that you voluntarily provide your Social Security Number to be used for the following purposes: 1. As an identification number in maintaining records, and 2. As an identification number for gathering information to be used for program evaluation and planning, as required under state and federal law. The Social Security number you provide could be shared and used by WorkSource Rogue Valley and other organizations authorized to use such information for the purposes stated above as allowed by the following federal and state laws: 1. WIOA sections 136, 185 and 188 (29USC 2871, 2935 and 2938), 2. ORS 285A.455 and 285A.461 When you allow WorkSource Rogue Valley to use your Social Security number, other documents we have with your SSN on them may be used for the same purposes as stated above.

    Failure to provide your Social Security number will not be used as a basis to deny you any service provided under Title 1B of the Workforce Investment Act. Other programs may request or require you to give your Social Security numbers as a condition of obtaining services. They will separately advise you of this if you apply for their program.

    Use of Your Social Security Number for Program Enrollment Purposes: If, as a result of your WIOA program participation, you become an employee of the agency through a work experience or other work related program or you receive on-the-job training, you will be required to provide your Social Security Number for payroll purposes. Your SSN will be used to report your Social Security earnings and to report your earnings for employee and employer tax purposes in accordance with the applicable state and federal laws. Your Social Security Number will not be given to the general public and your WIOA service records are confidential information and will not be released to the general public without your permission. The information below describes how your number will be used. Providing your SSN means that you agree to the use of the number in the manner described.


    Your SSN will be used by WorkSource Rogue Valley to keep information about you and the services you received through the WIOA program. Your SSN will also be given to the U. S. Department of Labor for the Standardized Program Information Record system. This information helps the federal government to prepare reports for reporting, monitoring and evaluating purposes. Your SSN will also be used by the Oregon Performance Reporting Information System to assist state and local agencies to plan education and training services to help Oregon citizens get the best jobs available. Your number will be used only for the purposes listed above. State and federal laws protect the privacy of your records.

  • Basic Information

  • If you have a disability, please answer the following questions:

  • Social Security Number

  • List all family members who are related by blood, marriage or decree of court living in your household and list their source of income and gross amount earned in last 6 months. If self-employed - list net business income.

    First Member:

  • Second Member:

  • Third Member:

  • Fourth Member:

  • Fifth Member:

  • Sixth Member:

  • Seventh Member

  • Please check services that you are currently working with:

  • Completion of this section is voluntary. You man choose not to fill it out without it having any affect on your application.

  • List current & previous employment for the past 6 months:


  • Job:

  • Job: