Basic Food Employment & Training(BFET) Individual ...



Client Name: FORMTEXT ?????EJAS ID: FORMTEXT ?????BFET Provider: FORMTEXT ?????Contractor Code: FORMTEXT ?????Case Manager: FORMTEXT ?????Date of Intake: FORMTEXT ?????Employment GoalsCareer Plan: FORMTEXT ?????Wage Expectation: FORMTEXT ?????Immediate Job Goals(s): FORMTEXT ?????Target Employment Date: FORMTEXT ?????Skills and QualificationsEducation FORMCHECKBOX High School Diploma or Equivalent FORMCHECKBOX College EducationDegree: FORMTEXT ????? FORMCHECKBOX Vocational TrainingCertificate: FORMTEXT ?????Work ExperienceNumber of employers in past 5 years: List Employment History on separate sheet FORMTEXT ????? FORMCHECKBOX No work experience in the past yearTransferrable Skills FORMCHECKBOX Customer service FORMCHECKBOX Solve problems FORMCHECKBOX Organized FORMCHECKBOX Write clearly FORMCHECKBOX Calculate, compute FORMCHECKBOX Manage people FORMCHECKBOX Speak in public FORMCHECKBOX Listening FORMCHECKBOX Run meetings FORMCHECKBOX Speak multiple languages FORMCHECKBOX Managing time FORMCHECKBOX Direct projects FORMCHECKBOX Communicate verbally FORMCHECKBOX Being punctual FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX Handle food FORMCHECKBOX Cooperating FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX Manage money FORMCHECKBOX Follow instructions FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX Take orders FORMCHECKBOX Construct or repair FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX Operate office equipment FORMCHECKBOX Drive or operate vehicles FORMCHECKBOX Other: FORMTEXT ????? FORMCHECKBOX Computer Skills FORMCHECKBOX Operate tools and machinery FORMCHECKBOX Other: FORMTEXT ?????Other QualificationsCertificate: FORMTEXT ?????Professional License: FORMTEXT ?????Other: FORMTEXT ?????Assessed Employment BarriersClient Employment BarriersServices to Address Barriers FORMCHECKBOX Skill Deficiency FORMTEXT ????? FORMCHECKBOX High School Diploma or Equivalency FORMTEXT ????? FORMCHECKBOX Lack of Qualifications for Desired Employment FORMTEXT ????? FORMCHECKBOX Lack of Employment History FORMTEXT ????? FORMCHECKBOX Limited English ProficiencyESL Level: FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Physical Health FORMTEXT ????? FORMCHECKBOX Mental Health FORMTEXT ????? FORMCHECKBOX Chemical Dependency FORMTEXT ????? FORMCHECKBOX Criminal Record affecting Employment FORMTEXT ????? FORMCHECKBOX General Identification (i.e. ID / Birth Certificate, Driver’s License, SSN Card) FORMTEXT ????? FORMCHECKBOX Resource Deficiency (i.e. childcare, transportation, personal hygiene) FORMTEXT ????? FORMCHECKBOX Housing FORMTEXT ????? FORMCHECKBOX Other: FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Other: FORMTEXT ????? FORMTEXT ?????Employment Plan FORMCHECKBOX Education/Training Plan FORMCHECKBOX VE FORMCHECKBOX BE (Including ESL) Educational Institution FORMTEXT ?????Dates of Training:From: FORMTEXT ?????To: FORMTEXT ?????Academic Goal: FORMTEXT ?????Degree/Certification: FORMTEXT ????? FORMCHECKBOX Job Readiness Training (JT) Job Search Training (i.e. resume writing; interview skills, master application, workplace etiquette)From: FORMTEXT ?????To: FORMTEXT ?????Work Experience (i.e. internship, OJT)From: FORMTEXT ?????To: FORMTEXT ????? FORMCHECKBOX Job Search (JS) Independent Job Search:From: FORMTEXT ?????To: FORMTEXT ?????Job Search with Assistance:From: FORMTEXT ?????To: FORMTEXT ????? FORMCHECKBOX Job Retention (BR) Ensure employment is verified. Component must be approved by the BFET program. From: FORMTEXT ?????To: FORMTEXT ????? FORMCHECKBOX Life Skills / Strategies For Success (SL) Training that increases adaptive abilities and positive behavior that enable participants to deal effectively with the demands and challenges of everyday life and employment.From: FORMTEXT ?????To: FORMTEXT ?????Declaration and SignatureThe following are the requirements to participate in the Basic Food Employment & Training (BFET) program:Receive Basic Food Assistance from DSHS;Be able to work at least 20 hours per week;Cooperate with the requirements of this Individual Employment Plan; andMeet with your BFET case manager at least monthly.I, , have read the requirements and agree to abide by them.(Print Name) FORMCHECKBOX Yes FORMCHECKBOX NoI understand this form and the contents have been explained to me in my primary language.Client SignatureDateCase Manager SignatureDateInterpreter Signature (required if client cannot understand this form in English)DateEmployment HistoryEmployer: FORMTEXT ?????Employment DatesFrom: FORMTEXT ?????To: FORMTEXT ?????Wages: FORMTEXT ?????Hours Per Week: FORMTEXT ?????Job Title: FORMTEXT ?????Work Performed: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????Employer: FORMTEXT ?????Employment Dates:From: FORMTEXT ????? To: FORMTEXT ????? Wages: FORMTEXT ?????Wages: FORMTEXT ?????Job Title: FORMTEXT ?????Work Performed: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????Employer: FORMTEXT ?????Employment DatesFrom: FORMTEXT ????? To: FORMTEXT ????? Wages: FORMTEXT ?????Wages: FORMTEXT ?????Job Title: FORMTEXT ?????Work Performed: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????Employer: FORMTEXT ?????Employment DatesFrom: FORMTEXT ????? To: FORMTEXT ????? Wages: FORMTEXT ?????Wages: FORMTEXT ?????Job Title: FORMTEXT ?????Work Performed: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????Employer: FORMTEXT ?????Employment DatesFrom: FORMTEXT ????? To: FORMTEXT ????? Wages: FORMTEXT ?????Wages: FORMTEXT ?????Job Title: FORMTEXT ?????Work Performed: FORMTEXT ?????Reason for Leaving: FORMTEXT ????? ................
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