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Employment Options
Free Job Placement for SSI/SSDI Recipients Through the Ticket To Work Program
New Client Referral Raffle Form
Client Referral Raffle Program Entry Form
Effective August 2014: Clients of Employment Options can use this form to submit a new referral of someone they know who is receiving SSDI or SSI benefits and are looking to return to work. **Before submitting this form, please ensure that the person you are referring has submitted an application to us online. We will check our application system and this person's application must be found in our system before awarding raffle tickets.
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?
*
Pam Barnette
Kimberly Bounds
Suzanne Cutler
Sandy Darnell
Lisa Seeley
Ethel Lawrence
Sarah Lind
Ray Morrison
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?
*
Spouse/Significant Other
Child
Friend
Co-worker
Neighbor
Family Member
Please verify your (our client's) current mailing address
*
Street Address
Address Line 2
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