Transitioning Service Member Inquiry

Please complete this brief inquiry form and a member of our team will follow up with you.

Name *

First Last

Phone Number *

TextMagic Phone Email

Email *

example@example.com

Branch of Service: *

Component *

Rank *

Current Military Occupational Code *

Unit *

Current Duty Station *

If outside AZ, what state/country?

Dates & location of deployments (if any):

Will you be a military retiree: *

Yes No

Have you began your service connected disability claim? *

Yes No

What is your desired occupation? (EX: Program Management, Medical Technician, Cyber Analyst, Electrician) *

Level Of Education *

No College/Some College Completed Associates Degree Completed Bachelor's Degree Graduate Degree

Years Completed *

High School Diploma or Equivalent Less than 30 credits Less than 60 credits Less than 90 credits 90+ credits

List all professional Certifications/Credentialing *

i.e. Lean Six Sigma, PMP, SHRM, HVAC, CCNA, COMP-TIA A+, etc.

Date entered the military: *

Date

What is your anticipated separation date? *

Date

Have you attended a transition assistance program? *

Yes No

Is your family member interested in career navigation resources? *

Yes No Unsure

Please share your family members email so we can send them the career navigation form: *

example@example.com

Do you have a spouse/partner? *

Yes No

Is your spouse/partner interested in career navigation resources? *

Yes No Unsure

Please share your spouses/partners email so we can send them the career navigation form: *

example@example.com

Will you be attending our orientation? *

Yes No

If not, please let us know why: *

Preferred Contact Day

Monday Tuesday Wednesday Thursday Friday Saturday

Preferred Contact Time

8am - 11am 12pm - 4pm 5pm - 7pm

Who were you referred by? *

If other, who were you referred by? *

Are you interested in doing an internship as you transition out of the military?

Yes No

Thank you for your interest in the DoD Career Skills Program:

SkillBridge is a Department of Defense authorized program for active duty service members separating from the military. With command approval, you may gain civilian work experience before leaving the military.

Has your commanding officer approved you for the SkillBridge program? *

Yes No In process Unsure

Where would you like to do your SkillBridge? (County) *

After submitting this form you will recieve an email with the step by step process and hear from the Career Navigation team within two to three business days.

Once you view our orientation and career readiness training, you can sign up for a virtual one on one with a Career Coach.

I consent to the following: *

I understand that I cannot conduct a DoD Skillbridge opportunity while on transitional leave. As soon as I am aware, I will disclose my intent to use or sell transitional leave. I will keep the Arizona Coalition for Military Families up to date with any changes to my timeline and transitional leave dates so that this can be communicated to potential employers.

I consent to the following: *

The Be Connected Career Program can make career connections and advocate on my behalf to employers.

Thank you and we look forward to working with you on your career navigation goals!