VR Client (Employee) Name: Date: CRP Agency: Employment Specialist: VR Counselor: Employer Site Information Business Name: Business DBA: Type of business: Address: County: Phone: Employee’s Supervisor: Employee Information Job title (Position): If this job is different than the IPE goal, please explain and describe steps to amend IPE: Job Duties: Work Schedule (Days/Hours): Permanent This position Temporary is: Seasonal Salary/ Wages: Benefits: Employment Start Date: Initial Placement Information On-Site Type of Support Needed: Off-Site None Required Training Aids/ Assistance Needed: Employee Transportation – Anticipated Date of Closure: Anticipated Need for Long Term Support:
VR Client (Employee) Name: Date: CRP Agency: Employment Specialist: VR Counselor: Employer Site Information Business Name: Business DBA: Type of business: Address: County: Phone: Employee’s Supervisor: Employee Information Job title (Position): If this job is different than the IPE goal, please explain and describe steps to amend IPE: Job Duties: Work Schedule (Days/Hours): This position is: Permanent Temporary Seasonal Salary/ Wages: Benefits: Employment Start Date: Initial Placement Information Type of Support Needed: On-Site Off-Site None Required Training Aids/ Assistance Needed: Employee Transportation Anticipated Date of Closure: Anticipated Need for Long Term Support: –