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First Name *

Last Name *

Middle Initial *

Last 4 of Social Security number 🛈

Zip Code *

Phone Number *

Email Address *

Are you between 16-24 years old? *

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Are you a veteran or veteran's spouse/caregiver? *

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How did you hear about this event? *

Your highest education level achieved *

Current needs:

I authorize the NM Workforce Connection to create an account in the www.jobs.state.nm system on my behalf if I do not have an existing account. The NM Workforce Connection will provide account information via the email address provided. *

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Flyer	Email	Facebook
Instagram	News	Radio
TV	www.wccnm.org website	Word of Mouth
Other (please specify) Other (please specify)

Did not receive High School Diploma	High School Diploma
Vocational school certificate	General equivalency degree (GED)
Years of college/Technical/Vocational School	Associate degree
Bachelor's degree	Master's degree
Doctorate degree	Specialized degree (e.g. MD, DDS)