Supported Employment (S.e.): Sample Reports And Forms

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Supported Employment (S.E.):
Sample Reports and Forms
Note: Sample forms not required but supported employment reports should include same types of information
1.Accept/Decline:
Use same form as for non-supported employment referrals
2. Sample JSS instruction Report Template for Supported Employment:
Number of hours Authorized_________
☐Resume Development: Date(s) ___________# of hours______________ (provide copy to participant.
Activities:
Save on thumb drive (to be provided by the agency) and provide to counselor.
Date(s) ___________# of hours______________ (provide copy to counselor).
☐Master Application:
Date(s) ___________# of hours______________
☐Interview Skills:
☐Dress, grooming hygiene
☐Answering interview questions
☐Mock interviews
Participant progress, strengths and needs: ________________________________________________________________
☐Other________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Date(s) ___________# of hours______________
☐Job Search:
☐ Identifying employers and good job matches
☐Networking (does participant or family have any contacts job developer can follow up on)
Participant progress, strengths and needs: ____________________________________________________________
☐Other________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Date(s) ___________# of hours______________
☐Work Behaviors:
☐Dress, grooming, hygiene
☐Attendance
☐Punctuality
☐ Interactions with supervisors
☐Interactions with co-workers
☐Work place expectations
☐Production—getting things done as expected
Participant progress, strengths and needs: ____________________________________________________________
☐Other________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Date(s) ___________# of hours______________
☐Other
Describe___________________________________________________________________________
______________________________________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________________________________________
Total hours of JSS Provided: __________________

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