Supported Employment Contract and Forms

000c Sample FY 2025 Contracts.zip

Download: FY25 Final-Sample Contracts.zip

ESS-C-801 Authorization Request & Billing Form Rev 2024-08-01

Download: ESS-C-801 Authorization Request & Invoice Rev 2024-08-01

 FY 2025 Supported Employment Services Contract Sample PDF 2024-06-14

Download: FY25 Supported Employment Services Contract Sample 2024-06-14.docx

ESS-C-117 Travel Log and Invoice Rev 2024-12-23

Download: ESS-C-117 Travel Log and Invoice Rev 2024-12-23

ESS-C-139 Situational Assessment Report (Rev. 2022-09-12)

Download: ESS-C-139 Situational Assessment Report (Rev 2022-09-12)

ESS-C-157 Pre-Placement Information Form Rev 2024-11-21

Download: ESS-C-157 Pre-Placement Information Form Rev 2024-11-21

ESS-C-161 Job Analysis Rev 2024-11-21

Download: ESS-C-161 Job Analysis (1) Rev 2022-09-22

ESS-C-173 Team Meeting Report (Rev. 2022-09-12)

Download: ESS-C-173 Team Meeting Report (Rev 2022-09-12)

ESS-C-181 Termination & Re-Placement Report

Download: ESS-C-181 Termination & Re-Placement Report (Rev 2023-11-27)

ESS-C-185 Job Accommodation Form Rev 2024-11-20

Download: ESS-C-185 Job Accommodation Form (Rev 2022-09-09)

ESS-C-213n O*NET median hourly wage documentation (for in-house placement only) (Rev. 2022-09-02)

Download: ESS-C-213n O*NET median hourly wage documentation (Rev 2022-09-02)

ESS-C-225 (1) Record of Hours Worked (Rev. 2021-09-23)

Download: ESS-C-225 Record of Hours Worked (Rev 2022-09-23)

ESS-C-225 (2) Record of Hours Worked SE ST (HC) (Rev 2022-09-22)

Download: ESS-C-225 (2) SE ST (HC) Record of Hours Worked (Rev 2022-09-22)

ESS-C-225 (4) EM Record of Hours Worked (for EM 90-day Milestone) (Org 2022-09-22)

Download: ESS-C-225 (4) EM Record of Hours Worked for EM 90-day milestone (2022-09-22)

ESS-C-229 Natural Supports & Fading Plan (Rev 2023-08-09)

Download: ESS-C-229 Natural Supports & Fading Plan (Rev 2023-08-09)

ESS-C-233 Employment Verification Form (Rev 2022-09-21)

Download: ESS-C-233 Employment Verification Form (Rev 2022-09-21)

ESS-C-237n Current Pay Stub or Earnings Statement (Rev 2022-08-12)

Download: ESS-C-237n Current Pay Stub or Earnings Statement (Rev 2022-08-12)

ESS-C-249 Employee Satisfaction Survey (Rev. 2021-09-09)

Download: ESS-C-249 Employee Satisfaction Survey (Rev 2021-09-09)

ESS-C-253 Extended Services Statement (Rev. 2022-09-12)

Download: ESS-C-253 Extended Services Statement (Rev 2022-09-12)

ESS-C-266 Employment Outcome Report Rev 2024-11-22

Download: ESS-C-266 Employment Outcome Report Rev 2024-11-22

ESS-C-278n DRS Counselor Response to ESS-C-278 Plan for Assessment (Rev 2022-07-08)

Download: ESS-C-278n DRS Counselor Response to ESS-C-278 Plan for Assessment (Rev 2022-07-08) 

ESS-C-289n Job Description (Rev 2020-02-25)

Download: ESS-C-289n Job Description (Rev 2020-02-25)

ESS-C-317n Copies of summary pages from vocational interest inventories (Rev 2022-09-08)

Download: ESS-C-317n Copies of summary pages from vocational interest inventories (Rev 2022-09-08)

ESS-C-325 Job Club Certificate of Completion (Rev. 2022-09-12)

Download: ESS-C-325 Job Club Certificate of Completion (Rev 2022-09-12)

ESS-C-338 R4 4-weeks Employment Report Rev 2024-11-21

Download: ESS-C-338 R4 4-weeks Employment Report Rev 2024-11-21

ESS-C-413 Highly Challenged Criteria Form (Rev. 2022-09-13)

Download: ESS-C-413 Highly Challenged Criteria Form (Rev 2022-09-13)

ESS-C-425 SE R8 Employment Report 2024-08-16

Download: ESS-C-425 SE R8 Employment Report 2024-08-16

ESS-C-430 Stabilization Report 2024-10-15

Download: ESS-C-430 Stabilization Report Rev 2024-10-15

ESS-P-182 SE-SES Termination & Re-Placement Packet SE-SES (Rev 2022-09-21

Download: ESS-P-182 SE-SES Termination & Re-Placement Packet SE-SES (Rev 2022-09-21).pdf