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CCS Service Facilitators -  Please fill out referral form

Thank you for considering a referral to EmployAbility/EmpowerAblity

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Before completing the referral form below, please acknowledge that you:
   - Have you discussed employment services with your client, and they are interested.
   - The client is available to meet between the hours of 9:00 am and 4:00 pm during the Monday to Friday work week?
   - The client understands:
         1. That we do not guarantee employment (if applicable)
        2. That we will work on skill development, and participation is required for success
        3. If they do not attend their scheduled appointment or cancel less than 24 hours before the appointment three times, services will be discontinued?

Do not enter sensitive information on this form, as we cannot guarantee security. Please contact our office with any addition information.

Thanks for submitting!

General Inquiries

Do not enter sensitive information on this form, as we cannot guarantee security. Please contact our office with any addition information.

Thanks for submitting!

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