COUNSELING RECORD/FSETP Worker __Iva K. Sloade_____

EMPLOYABILITY PLANDate Initiated__12-5-XXXX______

Date Closed______

  1. Name ___Abawd______Sally______D______000-00-0000______

LastFirstM.I.Social Security No.

  1. Address ___123 Main St, Frankfort, KY 40601______

Phone Number _(502) 564-0000__ Date of Birth _1/1/1970______Referral Source __ABAWD______

  1. Vocational Goal _Child Care Worker______6. Service Needs Checklist

______[ ] None required ______[ ] GATB

[ ] Child Care[ ] NATB

______[ ] Homemaker Service[ ] BOLT

[X] Home/Financial Mgt.[ ] Clerical Testing

  1. Alternative Job Goal(s) __Cleaning houses_[ ] Emp. Related/Remedial[ ] Interest Testing

Medical Care[ ] Orientation

______[ ] Voc. Rehabilitation[ ] Employability Skills

[ ] Legal Assistance Training

______[ ] Housing[ ] Adult Basic Educ.

[X] Transportation[ ] GED

  1. Reason Closed ______[ ] Bonding Assistance[ ] Classroom Training

[X] Work Experience[ ] OJT

______[ ] Skill Training*[ ] Other (Specify) ____

______

______*Explain training, location and length in Employability Plan below. Be sure to document plan and delivery or all services indicated.

  1. Circumstances __Sally has a driver’s license, but no vehicle. She is currently living with her aunt.______

______

______

  1. Employability Plan ______Applicant Will:______FSETP Will:______

_1. Enter into WEP agreement.______1.Put into suitable WEP placement____

_2. Participate the required monthly hours______2. Monitor progress______

_3. Keep appointments and be at WEP sites on time.______3. Counsel on job readiness______

_4. Return the FSET-145 monthly______4. Issue reimbursements timely.______

KentuckUnbridledSpirit.com An Equal Opportunity Employer M/F/D

  1. We agree to the employability plan outlined above and will strive cooperatively to fulfill it.

Applicant __Sally D. Abawd______12-5-XXXX______

SignatureDate

FSETP Worker __Iva K. Sloade______12-5-XXXX______

SignatureDate

Date/Worker Initials / Notable Events in the Progress of the Individual Through the Employability Plan
12-5-XXXX IKS / Completed up-front assessment as part of expedited appl. Scheduled appt to
return job search form on 1/6 at 10:00 am
1-6-XXXX IKS / Verified job search. Put into WEP slot. Start date will be 1-10-XXXX. Issued $25.
2-5-XXXX IKS / Signed – 145 for January. Issued $25
3-6-XXXX IKS / Signed – 145 for February. Issued $25
4-10-XXXX IKS / Signed – 145 for March. Issued $25

“In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of face, color, national origin, sex, age, religion, political beliefs, or disability.”

“To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.”

YOU MAY ALSO FILE YOUR COMPLAINT WITH THE CABINET FOR HEALTH AND FAMILY SERVICES, OFFICE OF HUMAN RESOURCE MANAGEMENT, EEO COMPLIANCE BRANCH, 275 EAST MAIN STREET, 5C-D, FRANKFORT, KENTUCKY 40621 OR CALL (502) 564-7770 EXT. 4107.

IF YOU HAVE OTHER COMPLAINTS ABOUT YOUR FOOD STAMP CASE, YOU MAY CALL THE OMBUDSMAN’S OFFICE AT 1-800-372-2973 or (TTY) AT 1-800-627-4702.