Supported Employment (S.e.): Sample Reports And Forms (Page 2 of 6) in pdf

Supported Employment (S.E.):

Sample Reports and Forms

☐Developed jointly with participant

3. Job Placement

Plan-use same template as for non-supported employment referrals

☐Individualized and specific responsibilities assigned according to needs and strengths of

participant

☐ Copy provided to participant and counselor

Authorized ☐yes ☐ no

If yes # of analyses authorized: ___________________

4. Preliminary Job Fit Analysis

Analysis #1: Employer and location: ___________________________________________

Date of job site visit___________________ Number of hours_______________

Activities ☐ informational interview ☐ job shadowing ☐ other_________________

Discussed pros and cons of job with participant: ☐ yes

Participant feels it is a good job match? ☐ Yes ☐ No

☐Other (explain) ________________

Why or why not? ______________________________________________________________

Job Developer feels it is a good job match:

☐ Yes ☐ No

☐Other (explain) ________________

Why or why not? ______________________________________________________________

If a good match will the employer consider hiring the client? ☐ Yes ☐ No explain: ______________

_______________________________________________________________________________________________________________

5. Job Development: (monthly reports)

Month: June 2014

Week of June 1

2014

Met w/ client, assisted him to identify organizations that hire for lobby attendants.

Sample #1:

Discussed possible pros and cons of each company that is hiring in order to help determine which would be a

good fit for him. Based on our research client choose to submit applications with XXX, YYY and NNN.

Assisted him to complete and submit applications.

Week of June 8, 2014:

Called XXX and YYY to follow up on client’s application.

XXX indicated they will

review application and get back to me. Left message for YYY. Dropped by NNN Company, as they seemed to

be the best fit for him. Introduced self- to HR manager, explained supported employment, advocated for

interview. HR manager to discuss with supervisor

Week of June 15, 2014 Dropped by YYY—no one available to meet with me

Called client to update. He is

going out of town for a few days and will not be available for interviews. We agreed I would wait until next

week to follow up with all three employers.

Week of June 22, 2014 Contacted XXX. They indicated they have more qualified applications to interview.

Called YYY again, left another message. HR Dept. at NNN arranged for me to meet with unit supervisor at

NNN. Explained supported employment, advantages, incentives etc. They agreed to interview client. Met

w/ him prior to the interview to familiarize client with NNN environment, company expectations and

priorities, discussed possible questions unique to this company. Accompanied client to interview, he did well

in interview. Employer will notify when a decision is made

Supported Employment (S.e.): Sample Reports And Forms Page 2

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