MIJOB - Getting Started: Michigan Job Placement Service for People with Disabilities. Creating unique companies: unique employees: unique rewards.

getting started

In order to initiate services, please fill out the enclosed form as completely as possible. You will receive a call within 24 business hours.

Thank You!

Date:
Participant's Name:
Street Address:
City:
State:	Zip:
Phone:	Voice TDD/TTY Both
Date of Birth:	Social Security Number:
Drivers License or State ID Number:
Primary/Secondary Disabilities:
Living Situation:
Medications:
Education:
Work History:
Barriers to Employment:
Emergency Contact:
Night Phone:	Voice TDD/TTY Both
Comments

Services Requested

	Placement		Job Coaching Hours:
	Re-Placement		Employability Tutoring Hours:
	Job Shadowing
	Follow-Along Services
	3 months 6 months One Year

Thank You

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