New Client Referral Raffle Form

Employment Options' Client Name (Our current client)*

First Last

Note: This is field is for current Employment Options's clients who is making the referral.

Your Main Phone Number*

What is your most current email address?

Enter Email Confirm Email

Who is your Employment Options' Job Counselor?*

Has your referral submitted an application on our website,***

Yes, my referral has submitted an online application
No, my referral has not submitted an online application

**Note: Your referred job seeker must have a submitted an online application in our system in order for you to receive proper credit for the referral. Please put valid contact information. We will verify with this person. Application link for referred jobseeker: http://myemploymentoptions.com/apply-now/

You answered that your referral has not yet submitted an application to us online. Please do not submit an entry form until you know your referral has submitted an online application to us. We will check our system and look for this person's name and contact them. Application link to refer new jobseekers: http://myemploymentoptions.com/for-job-seekers/

Name of Job seeker Who Are Referring?*

First Last

MUST BE RECEIVING SSDI/SSI (non retirement) disability benefits and be 18-64 years old.

Main phone number of person you are referring?*

Please put a good number to reach them.

What is a second phone number for your referral?

Email Address of the new referral to MEO

What is the relationship of this person to you?*

Please verify your (our client's) current mailing address*

Street Address Address Line 2 City State ZIP Code

Employment Options

Free Job Placement for SSI/SSDI Recipients Through the Ticket To Work Program

Client Referral Raffle Program Entry Form