CareerLink Referral Form CareerLink Referral Form CareerLink Referral Form CareerLink Referral FormWhen you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.Case Manager NameCase Manager EmailDepartment CCHIP/HUD Community Referral Emergency Shelter FRC HOPWA Operation HomeClient Full NameClient Unique ID #Client EmailClient Phone NumberDoes the client have stable housing? Yes NoDoes the client have children in the home under 18 years of age? Yes NoDoes the client have adequate childcare for minor children? Yes No Not ApplicableIs the client currently pregnant? Yes NoClient's education level High School Dropout High School Diploma/Equivalent College Degree Trade CertificationEmployment Status Not Employed Employed Part-Time Employed Full-TimeWhat is the client's motivation level to find work? 1 2 3 4 5 6 7 8 9 10Citizenship Status U.S. Citizen Permanent Resident Dreamer Not a U.S. CitizenDisability Status Physical Disability Mental Health Disability NoneClient's Primary LanguageMilitary Status Veteran Not a VeteranMarital Status Single Married Divorced Widowed Separated Domestic PartnershipDoes the client have valid I-9 Documentation? Yes No PendingBarriers to Employment (Select all that apply) Transportation Childcare Physical Ability Work Skills Criminal Background OtherAre there any notes that would be helpful to us for this client?A PDF copy of your responses will be included in the confirmation email for your records.Submit Form
