Gig Worker Reintegration Plan Form

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please provide your current address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

What is your current employment status?

Other

Briefly describe your recent gig work experience (roles, duration, companies/platforms)

What are your main skills and qualifications?

Which types of gig work or industries are you interested in? (Select all that apply)

What challenges have you faced in returning to work? (Select all that apply)

Which support services would help you most in your reintegration? (Select up to 3)

What are your primary goals for reintegration?

What is your typical availability for work?