This document contains personal and contact information for an individual named Chalermch Chaviengh. It includes their name, address, phone number, email, date of birth, citizenship status, education level, employment status as unemployed and looking for work, desired occupation as a chef or head cook, and responses to questions about disability, farm work experience, ethnicity, race, and military or veteran status. Required fields are marked with red indicators.

1. [ My Portfolio ]
My Individual Profiles
My Individual Plans
General Information Background Activities Memo
 Type of business worked in is a required field.
 Have you worked on a farm or as a migrant/migrant food processor at least 25
days in the past 12 months? is a required field.
indicates required
fields.
For help click the question mark icon next to each
section.
Login Information
User Name:
CHAVIENGHONG7706
Change User Name
Password:
Click here to change password
Security Question:
What is your mother's maiden name?
Security Question Response:
Mouse
Name
First Name:
CHALERMCH
Middle Initial:
Last Name:
CHAVIENGH
Residential Address
Address Line 1:
1799 Sandra

2. Address Line 2:
City:
Palm Springs
State:
Florida
Zip Code:
33406
Find zip code
County / Parish:
Palm Beach County
Country:
United States
Mailing Address
Check here to use residential address information
Address Line 1:
1799 Sandra
Address Line 2:
City:
Palm Springs
State:
Florida
Zip Code:
33406
Country:

3. United States
Phone Numbers
Primary Phone:
561
-
968
-
1240
Ext: Type:
Home
Alternate Phone:
561
-
307
-
7974
Ext: Type:
Cell/Mobile Phone
Text Message Cell Phone Number:
561
-
307
-
7974
For receiving virtual recruiter job alerts
Fax:
- -
E-mail Address
Primary E-mail:
rachavat197
Create E-mail Account
Read Our E-mail Security Policy
Confirm Primary
E-mail Address:
rachavat197
Preferred Notification Method
Please select a method in which you prefer to receive your notifications:
Internal Message
Site Access
Accessing the web site from?
One Stop Center

4. How did you hear about this website?
None Selected
Demographic Information
Date of Birth:
12/05/1955
(mm/dd/yyyy)
Age:
58
Gender:
Female Male
Have you registered with the Selective Service?
Not applicable
[ Selective Services web site ]
(Please Note: You may be eligible for additional support services and programs.)
Citizenship
Citizenship
Alien/Refugee Lawfully Admitted to U.S.
USCIS (Alien Registration) Number:
099142947
e.g. A123456789
USCIS (Alien Registration) Expiration Date:
08/17/2015
(mm/dd/yyyy)
Disability
Do you have a disability?
(As defined in Section 504 of
Rehabilitation Act of 1973)
Yes, I have a disability.
No, I do not have a disability.
Not Specified
Providing this information is optional and refusal to provide disability information will not subject you
to any adverse treatment. Information regarding your disability status will be kept confidential as
provided by law and will be used only in accordance with the law. Please note that for some

5. programs, the information is needed to determine eligibility. Note too that you may be eligible for
additional support services and programs if you have a disability.
Education Information
Your Highest Education Level Achieved:
Bachelor's Degree
If you have High School Diploma or GED please select the appropriate value of High School Diploma
or GED
Are you attending school?
No, Not Attending Any School
Employment Information
Current Employment Status:
Not Working
Within the last 12 months, have you received a notice of termination or layoff from
your job or received documentation that you are separating from military service:
Yes, I have recently
received a notice of termination
or military separation.
No, I have not recently
received a notice of termination
or military separation
Type of business worked in:
None Selected
!
Are you receiving Unemployment Insurance?
Yes, Claimant, not referred by PREP
Are you currently looking for work?
Yes No
Desired Job

6. Please enter a job title below. As you are entering the job title, you may see a list of
common job titles similar to what you are entering. If you see your job title in the list,
select it.
What is your desired job title?
Chefs and H
Below is a list of suggested occupations based on the job title entered. If you see an
occupation that matches your job title, select it and this will set the occupation.
Suggested occupation(s):
Chefs and Head Cooks
Occupation Title:
Chefs and Head Cooks
Occupation Code:
35101100
If you feel the suggestion list does not contain an accurate occupation, click
the Search for an occupation link below to find one.
[ Search for an occupation ]
Farm Worker Information
Have you worked on a farm or as a migrant/migrant food processor at least 25 days
in the past 12 months?
Yes No
!
Ethnic Origin
Are you of Hispanic or Latino heritage?
Yes No Not Specified
Race - Please check all that apply:
African American/Black
American Indian/Alaskan Native
Asian
Hawaiian/Other Pacific Islander
White
I do not wish to answer.
Military Service

7. Veterans and their spouses may be entitled to State and Federal Benefits. Please
answer the following questions.
Are you currently in the military, a veteran or the spouse of a veteran?
Yes No
Are you the Spouse/Dependent of someone in the active-duty military service,
National Guard or Reserves who is currently activated?
Yes No
Are you a current member of the Florida National Guard?
Yes No
Save
Cancel