HOW TO COMPLETE THE COLORADO EMPLOYMENT FIRST ASSESSMENT FORM
The Employment First Program requires that an assessment form be completed for each participant within 25 days of the first appointment or orientation.
The purpose of the assessment is to identify any barriers the participant may face in gaining employment, find out what other agencies they are working with, and get an accurate picture of the person's skills and work experience. It is the job of the case manager to ensure that any barriers are addressed by supplying available supportive services either directly from the Employment First program or through another community based organization.
The assessment should also guide decisions on what participation plan is most practical for the participant.
Section I:The boxes at the top of the form ask for basic information about the Employment First participant including their name, SSN (last 4 digits), date of birth, address, phone number and/or message number, and email address.
Section II:
This section is divided into three columns:
Personal Data - 16 questions the participant responds to by either checking one of the given choices or by
writing in an answer.
Staff Use Only - space for the case manager to respond to the answers given by the participant.
Key- corresponds to the first letter of one of the answers to the question under the Personal Data column.
“Y V” If the participant answered yes, verification is required.
“Y” Case Manager will explain in the “Staff Use Only” section how the barrier will be overcome.
Section III:
Staff Use Only – Case managers are required to complete this section to determine the next step for the
participant.
The following is a list of all the questions, the answer the "key" response refers to, and an example of how the case manager may respond in the "Staff Use Only" section if the participant selects the key answer.
Question #1: Are you currently employed? Key - "Y” Staff Use Only “V” Verification
The case manager must make sure the participant completed the following questions:
Full/part-time/Temporary/Day Labor (circle one):
If the person is not working enough hours to exempt them from EF participation (30 hrs/wk), find out more about their schedule.
Will their work hours interfere with attending classes or appointments? Is the work temporary or permanent?
Start date:
The purpose of this question is to determine whether or not the participant is currently working, and if the employment information has been entered on CBMS.
The case manager should enter any recent employment disclosed by the participant that is not on CBMS.
Kind of Work:
Again, used to verify and report employment. May also be used to gain understanding of the type of work the individual is able to do and willing to perform.
# Hrs per week:
Participants working 30 hours a week are exempt from participation in Employment First.
If a client is working 30 hours a week for a friend or family member and making no money, they must provide evidence of the necessity of the work they are doing and be able to establish in-kind value they are receiving for the work.For example, if they are babysitting, they must prove that their employer is working and there are dependent children who need care, and in return they are receiving room and board valued at $$.
Hourly wage:
Combined with the number of hours worked per week, the hourly wage will be used in determining whether or not an individual is earning enough income to exempt them from participation in the program. Remember, however, that a person may be self-employed or working on commission for 30 hours/wk, earning no income, and still be exempt from the program for a reasonable length of time.
.Company Name:
Needed to verify current employment before entering it into CBMS. Also used to report employment information to the FA technician.
Phone Number:
Needed to verify current employment before entering it into CBMS.
Are you on temporary layoff and expected to return to work within 60 days?
The purpose of this question is to determine if the participant may be job attached.
The case manager needs to verify the name of the employer, and why the participant was laid off. Was there a temporary layoff of many employees; is it seasonal or a teacher position where the school is closed in the summer?
Question #2: Please circle any of the following benefits you are currently applying for or receiving:
Key - "Y” – Staff Use Only “V” Verification
UI (Unemployment Insurance)TANF (CO Works or Family Preservation)
AND (Aid to the Needy Disabled)SSI (Supplemental Security Income)
CRSP (Colorado Refugee Services)Veterans 100% Disability
The case manager must determine if client is actually receiving benefits that would allow an exemption .If they are receiving benefits, this can usually be verified via CBMS. Application information may require hard copy documentation. Determine if the client has documentation with them. If so, write in the Staff Use Only section “copy of documentation in file - will send to FA Office”.
If client states that they have applied but do not have documentation, in Staff Use Only, write that client is to provide verification within 10 days.
Question #3: Are you responsible for the care of a dependent child in your household?
Key - "Y” – Staff Use Only “V” Verification
It is important for the case manager to look at the ages of the children. If they are under the age of six, was the person referred in error?
The participant is a non-ABAWD if there are children under 18 years of age in the household.
Is daycare needed?
- Any children under the age of 13 require adequate day care. Does the person have day care arrangements made? If no, can a friend, relative or neighbor provide this service? The case manager must assist the individual in handling this barrier by providing day care money under participant reimbursement if needed or by referring them to a local agency that can help.
- The case manager may also need to pro-rate hours if the participant has day care issues or must drop off and pick up children from school. A non-ABAWD may be deferred in the summer if they do not have proper day care for children when out of school; this should be updated in case comments.
Question #4: Are you responsible for the full-time care of an incapacitated person?
Key - "Y” – Staff Use Only “V” Verification
Participant may be exempt from participation if they provide medical verification from the incapacitated persons’ doctor. The case manager should note the doctor’s name and phone number and that documentation is required from participant.
Question #5 High School (Circle highest grade completed): 9 10 11 12 Key - "U 12" for "Under 12th grade"
Diploma? ____ Yes ____ NoGED ____ Yes ____ No
The case manager must encourage participants to take Adult Basic Education/GED classes if they have not received their high school diploma or GED certificate. If the participant agrees to a referral, the case manager notes that the participant has been referred to a GED program.
For example, "Referred to community college for GED classes to begin 7/1/13." However, the participant may either refuse to go to GED classes or they may feel desperate to find work. If this is the case, the case manager needs to indicate this on the assessment form either by writing, "Participant does not wish to attandclasses “or” Participant stated that they really need to work right now and will not participate in GED at this time."
Are you currently in school? Key - "Y” – Staff Use Only “V” Verification
Name of school or program:
Case manager must determine if participant is an ABAWD and meeting the work requirement as a student, or if school is a possible exemption. The case manager needs documentation in order to enter school exemption information into CBMS.
Start Date:
Start date may determine if exempt from Employment First.
Anticipated End Date:
May be used to set end date on component contract. Will also determine how long you will need to track their participation.
Days & Hours:
Days & Hours are required to determine if attending school enough hours to be exempt or meeting the work requirement.
Kind of Training:
Case manager should determine the type of training to make sure it is not just a crafts class at a recreation center.
Question #6: Are you currently enrolled in a Vocational Rehabilitation program?
Key - "Y” – Staff Use Only “V” Verification
Participant is exempt if enrolled in a Vocational Rehabilitation program prior to applying for food assistance.
Question #7: Are you a veteran? Key - "Y” – Staff Use Only
If the participant indicates they are in active military status, gather information on whether this is, in effect, a job, or if it is just a pay status. If the participant is a veteran, the case manager should be sure they have information on Veteran's services available in the county.
Question #8: Are you currently homeless? Key - "Y” – Staff Use Only
Many people are in varying degrees of homelessness so the case manager needs to clarify the situation by asking questions such as the following:
Are they currently staying in a local shelter or are they living on the street? If they are currently staying in a shelter ask how long they can stay there. What will they do when their time runs out? If they are currently living on the street, the case manager should provide them with the names and addresses of shelters and other services available for the homeless in their community.
If they are not in a shelter or living on the street, are they staying with friends or relatives? How long will they be able to do so? Do they have a back-up plan if things change and they are no longer able to stay there?
Question #9: Do you have a valid I.D.? Key - "N” – Staff Use Only
Determine if the participant truly has no valid ID and indicate how this problem will be resolved. Employers are required to complete an I-9 form for each new employee to verify citizenship. Employment First participants may not be hired for work if they cannot produce identification. To remove this barrier, the case manager may refer the person to an agency that can help them obtain either a Colorado I.D. or driver's license; or the program may be able to pay for such I.D.s with their participant reimbursement fund. Call your local Motor Vehicle Department to determine the cost.
Question #10: How will you get to work/classes? Key - "DK” for “Don’t Know” – Staff Use Only
If the person responds by checking "don't know" the case manager must determine if this is a real barrier to job search and employment and must indicate how the barrier has been resolved.
The process of identifying alternatives may include a series of questions including: Can they car pool with someone or is there a car they can borrow? Can someone drop them off? Are things within walking distance? Is there a vanpool or free shuttle system available?
The case manager may also offer bus tokens, bus passes or gas vouchers depending upon what is available in their county.
Question #11: Are you registered with the WORKFORCE CENTER? Key - "N” – Staff Use Only
Some counties require participants to enroll with the Workforce Center. The case manager may use the "Staff Use Only" section to determine if the participant is fully registered.
Are you currently working with another agency to find employment? Key - "Y” – Staff Use Only
Name of Agency: ______
Type of Assistance: ______
Contact Person: ______
If the participant indicates that they are currently working with another agency or program, it is important to know more about their involvement. Do they need to report regularly for classes or appointments? Is this on a voluntary basis or are they expected to fulfill requirements with this other program? Do they check in weekly just to look at their job board?
Depending upon their level of involvement, the case manager may ask the participant to provide verification of enrollment from the other agency. The case manager may sign a component contract with the participant to continue working with this agency.
If their level of involvement with the other program is not sufficient to fulfill the requirement of the Employment First Program, the case manager would assign them to another component in the EF program.
Question #12: Are you currently involved with the court system? Key - "Y” – Staff Use Only
Are legal problems going to interfere with job search and employment? How have you resolved this barrier?
The case manager should ask for more details. Do they have specific court dates set? How many? Is this going to be a long-term or short-term process?
Have you ever been convicted of a felony?
Clarify the potential impact of this on finding employment. Did the person serve prison time? Depending on the kind of work they are seeking, the nature of the felony may be important. For example, an embezzlement conviction would affect the suitability of an accounting or bookkeeping position.
Are you on probation or parole?
Does this require regular appointments with a probation officer? Will these appointments interfere in any way with them attending classes or Employment First appointments?
Name/Phone Number of PO
Have you ever been convicted of a misdemeanor?
Clarify the potential impact of this on finding employment. Insure that the individual is prepared to handletough questions they may face on their applications and in their interviewing.
Question #13: Are you currently in a Domestic Violence program that would prevent you from looking for work?
Key - "Y” – Staff Use Only “V” Verification
If the participant is in a Domestic Violence program and feels that looking for work may put them at risk, request documentation to temporarily defer.
Question #14: Are you currently in drug or alcohol treatment? Key - "Y” – Staff Use Only “V” Verification
Participant is exempt if enrolled half-time or more in a Drug/Alcohol treatment program.
AA program is not an exemption.
Question #15: Do you have any physical conditions that limit your ability to work?
Key - "Y” – Staff Use Only “V” Verification
Participant may have physical limitations or be unable to work. The case manager should inquire as to the last time the participant was seen by a physician and if they can provide medical documentation for a possible exemption. If the participant has physical limitations but is still able to work, the limitations should be considered when placed on Workfare sites.
Are you pregnant? ______Yes ______Expected delivery date _____ No
Participants may be in early months of pregnancy and not easily visible, case managers should request medical documentation for exemption.
Do you have medical needs which are not being treated?
Untreated medical needs must be evaluated as to their effect on job search and employment. The participant must be given available information on places or programs that can work with them to get the medical care needed.
Do you have any mental conditions that limit your ability to work? _____ Yes _____ No
Mental conditions are not always easily detected. The case manager should inquire as to the nature of the mental condition and consider questions such as is the participant: able to work around people; taking medications; and/or receiving treatment. The case manager needs to determine if medical documentation is required for possible exemption or if the condition should be considered when being placed on Workfare sites.
Are you currently taking medications that could affect your ability to look for work?
The case manager needs to determine if medical documentation is required for possible exemption or if condition should be considered when being placed on Workfare sites.
Non-ABAWDs with severe disabilities that are not readily visible may be excused from the program by putting their CBMS case in Deferred Status.
ABAWDS can only be exempted with written medical verification or by calling the State office to have them put in 15% exempt status.
Those who are not exempted because their restrictions are not severe enough to prevent them from working may either be referred to a vocational rehabilitation program or the case manager may work with them directly to place them in employment that can accommodate their restrictions.
If the person is not exempted there are some important questions to be considered: What are the work restrictions? Given the restrictions, what type of work can be considered? Does the person have the skills or experience to perform the duties required? Do they need additional training? What other alternatives are there?
Question #16: What do you think is your biggest barrier to employment?
SECTION III
Case managers are required to complete this section to determine the next step for the participant.