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Job Placement Contract and Forms

Employment Support Services

OK Library for the Blind and Physically Handicapped
300 N.E. 18th Street
Oklahoma City, OK 73105

Office: (405) 522-2123
Toll Free: (800) 523-0288
Fax: (405) 522-2139

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ESS-P-M5-ER Packet (2022-09-23)

Download: ESS-P-M5-ER Packet (Orig 2022-09-23).pdf

000f FY 2023 All Forms (Official) (ZIP File) (132 MB)

Download: 000f FY 2023 All Forms (Official).zip

000fc All FY 2024 All Contracts All Forms Checklists (Official) (PDF)

Download: All FY 2024 All Contracts All Forms Checklists into single PDF file

007c FY 2024 Supported Employment Services Contract Sample) (PDF)

Download: FY24 Supported Employment Services Contract (Final-Sample) 2023-06-05.docx

007f FY 2023 SE Forms (Official) ZIP File

Download: 007f FY 2023 SE Forms (Official).zip

007fc FY 2023 M0-SE Contract Forms Checklists (Rev 2022-09-14) ZIP File

Download: 007fc FY 2023 M0-SE Contract Forms Checklists (Rev 2022-09-14).zip

ESS-A-020 Incentive Payment Form (Rev. 2023-08-21)

Download: ESS-A-020 Incentive Payment Request Form (Rev 2023-08-21)

ESS-C-117 Travel Log and Invoice (Rev. 2024-03-06)

Download: ESS-C-117 Travel Log and Invoice (Rev 2024-3-06).pdf

ESS-C-133 DRS Counselor Monthly Update Form (Rev. 2021-08-11)

Download: ESS-C-133 DRS Counselor Monthly Update Form (Rev. 2021-08-11)

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 2023-11-27)

Download: ESS-C-157 Pre-Placement Information Form (Rev 2023-11-27)

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

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

ESS-C-161 (2) Job Analysis (Rev. 2022-09-22)

Download: ESS-C-161 (2) Job Analysis (Rev 2022-09-22)

ESS-C-166 Job Development & Placement Report (Rev. 2023-12-08)

Download: ESS-C-166 Job Development & Placement Report (Rev 2023-12-08)

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 2022-09-09)

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. 2022-09-13)

Download: ESS-C-266 Employment Outcome Report (Rev 2022-09-13)

ESS-C-278 Plan for Assessment (Revised 2022-09-12)

Download: ESS-C-278 Plan for Assessment (Rev 2022-09-12)

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-297 Compatibility Analysis (Rev. 2022-09-12)

Download: ESS-C-297 Compatibility Analysis (Rev 2022-09-12)

ESS-C-297 Compatibility Analysis (Rev. 2022-09-12)

Download: ESS-C-297 Compatibility Analysis (Rev 2022-09-12)

ESS-C-310 Assessment Milestone Report (Rev. 2022-09-12)

Download: ESS-C-310 Assessment Milestone Report (Rev 2022-09-12)

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-321 Job Club Sign-in Sheet (Revised 2022-09-12)

Download: ESS-C-321 Job Club Sign-in Sheet (Rev 2022-09-12)

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) Milestone Report (Rev. 2023-08-09)

Download: ESS-C-338 R4 Milestone Report (Rev 2023-08-09)

ESS-C-398 SE Authorization Request & Invoice (Rev 2022-09-23)

Download: ESS-C-398 SE Authorization Request & Invoice (Rev 2023-08-15).pdf

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 Milestone Report (Rev 2023-08-09)

Download: ESS-C-425 SE R8 Milestone Report (Rev 2023-08-09)

ESS-C-430 Stabilization Milestone Report (Rev 2022-09-12)

Download: ESS-C-430 Stabilization Milestone Report (Rev 2022-09-12).pdf

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

ESS-P-M1-SE Packet (Rev 2022-09-23)

Download: ESS-P-M1-SE Packet (Rev 2022-09-23).pdf

ESS-P-M2-SE Packet (Rev 2022-09-23)

Download: ESS-P-M2-SE Packet (Rev 2022-09-23).pdf

ESS-P-M3-SE Packet (Rev 2022-09-23)

Download: ESS-P-M3-SE Packet (Rev 2022-09-23).pdf

ESS-P-M4-SE Packet (Rev 2023-03-09)

Download: ESS-P-M4-SE Packet (Rev 2023-03-09.pdf

ESS-P-M5-SE Packet (Rev 2022-09-23)

Download: ESS-P-M5-SE Packet (Rev 2022-09-23).pdf

ESS-P-M6-SE-HC Packet (Rev 2022-09-23)

Download: ESS-P-M6-SE-HC Packet (Rev 2022-09-23).pdf

ESS-P-M6-SE-REG Packet (Rev 2022-09-23)

Download: ESS-P-M6-SE-REG Packet (Rev 2022-09-23).pdf

ESS-P-M7-SE Packet (Rev 2022-09-23)

Download: ESS-P-M7-SE Packet (Rev 2022-09-23).pdf

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