With the GiveDirect
credit card processing service, no fees are taken on your Visa or Mastercard
donation. We receive 100% of your gift. A low fee of 2.85% is deducted from
American Express donations.
So give with
confidence to GiveDirect,
disABLEDperson Inc. is looking for Corporate Sponsors, would you like to be one and support the disability community? If so, please contact us at 760-420-1269. Click here for suggested rates!
Community for the disABLED
|
|
disABLEDperson Inc.
PO Box 230636 Encinitas. Ca. 92023-0636. 760-420-1269 EIN-33-0937618
disABLEDperson Inc as an EN offers online services only. The services we offer for the beneficiary are an online job matching service and content specific to writing resumes and job interview and accommodations. Our services are for the self motivated individual.
Beneficiary Name
____________________________________________ Address
____________________________________________________ Telephone
No._____________ SSN #
______________________ Beneficiary’s
Legal Representative, name, phone number,( If
applicable)______________________________________________________________ Beneficiary’s
Date of Birth______/_______/_____________ Email address (if
you have
one).ญญญญญญญญญญญญญญญญญญญญญญญญญญญญญ________________________________________ Beneficiary’s
Gender (M)_____(F)_______ Are you currently a Vocational Rehabilitation Client Yes___No___ Are you currently working with an Employment Network. Yes___No__.If you are currently working with an Employment Network, what is their name address and phone number______________________________________________________________________________ Why are you leaving them and assigning your Ticket to disABLEDperson Inc. Work Background Please briefly describe work
experience and latest
employment._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Education Background Please describe the highest
level of education that you have completed and your degrees
obtained (if
any).___________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are you currently working? (Y)___(N)____ If you are working,
please indicated you hourly, weekly or monthly pay $________________ and the number of
hours that you work per day, week or month _____________________. Vocational Goal: Prior to mailing this form back
to us, please write in the space provided a statement of what your Vocational Goal(s) is
(are). disABLEDperson Inc. understands that your goals might
change.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What date do you expect to start work? ______________________
Please leave this blank if you are already working! Is one of your employment goals to receive
employer offered benefits? (Y)___(N)____ How far are you willing to travel from your
home to your work?___________________miles. What is the hourly or weekly or monthly salary
that you expect to make? $______________ How many hours do you expect to work per day or
week or month__________hours. Do you anticipate being a waged employee or self
employed? Please circle which one. Please circle the expected category of job that you
seek according to the EEOC classification: Executive/Managerial, Professional, Sales,
Technical/Paraprofessional, Skilled Craft, Secretarial/Office/Clerical/Service Worker,
Operative, Laborer. Please put down your expected Occupation______________________________________ If I am unable to
achieve the occupational objective circled above, I am willing to explore alternatives on
disABLEDperson Inc.’s recruitment application, recruitABILITY. (Y)__(N)___ Services and Supports to be Provided By signing this
IWP/Contract and submitting it to disABLEDperson Inc,. the beneficiary or legal
representative understands and accepts that the pre-employment services provided by
disABLEDperson Inc. to the Ticket Holder will
be Internet (web based) services only. We will
provide a job message board where the Ticket holder can place their resume for job
consideration. We will also provide the Ticket holder free of charge the ability to search
our database of job listings. disABLEDperson Inc. will also provide content to the Ticket
Holder that deals with “The Job Interview”, “Accommodations”, and
“Resume Writing. What is the approximate date that you are expecting to
start services from disABLEDperson Inc.____________? The web based services offered by
disABLEDperson Inc. are available to you at any time. You need not assign your Ticket to
us to utilize or services. What is the approximate date that you expect to
complete services offered by disABLEDperson Inc.______________? disABLEDperson Inc.
suggest that you pick a date at least 5 years from the date of you signing this IWP
(today’s date) as disABLEDperson Inc’s payments from SSA can continue for 5
years after you have stopped collecting from them. I understand that I can access disABLEDperson
Inc’s web based services as often as I like. I also understand that disABLEDperson
Inc. will not provide me, the beneficiary with any special equipment or services to access
their web based services. I understand that if I am not happy with the services
provided to me by disABLEDperson Inc. that I can retrieve my Ticket and reassign it to a
new EN. I can begin that process by calling 760-420-1269. I understand that if I am unable to actively
pursue my employment goals for a period in excess of 90 days, that I am obligated to
inform disABLEDperson Inc. so that they can classify my Ticket as in-active. disABLEDperson Inc.
EIN-33-0937618 disABLEDperson Inc.
may not request or accept any compensation from you for the costs of services and supports
we provide you. This IWP may be
amended by you or disABLEDperson Inc. if both
parties agree. disABLEDperson Inc.
may end this relationship if no longer able or willing to provide services as planned. The Ticket to Work
and Self-Sufficiency Program will provide disability beneficiaries more choices for
receiving employment services and increase provider incentives to serve these individuals.
Under the program, SSA is directed to provide disability beneficiaries with a Ticket they
may use to obtain employment services, VR services or other support services from an EN of
their choice. You may retrieve your Ticket at any time if you are dissatisfied with the
services and supports being provided by disABLEDperson Inc. If you and
disABLEDperson Inc are unable to resolve any disputes about the services and supports
being provided, the internal dispute resolution process will be available to you. You may
also contact P&A in YOUR STATE. For assistance, go to the web site http://www.napas.org and put your state in the search box
to pull up your local contact. Or you can call
Phone: (202)-408-9514, Fax : (202)-408-9520, TTY:
(202)- 408-9521. Your personal
information including your Social Security number and information about your disability
will be kept private and confidential. Only qualified
employees and/or providers will be used to furnish services. disABLEDperson Inc. offers only web based
services. There will be no medical or related health services. A copy of this IWP
will be provided to you in an accessible format at any time if you so choose. By signing this IWP/Contract, I verify that I
have read, understand and I am in agreement with all the statements on it. Prior to signing
this IWP, please review to make sure that your have responded correctly to all questions. __________________________________
______________________________ Beneficiary’s
Signature
disABLEDperson Inc.’s Diana Corso __________________________________
______________________________ Date
Date Please mail IWP to disABLEDperson Inc. After receiving and
reviewing your IWP, if appropriate, it will be approved and a signed copy will be mailed
to you for your record keeping. Please allow
2-3 weeks for this process. disABLEDperson Inc.
EIN-33-0937618 |
