• Department of Labor - Central Intake/Referral Form

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  • Certification

    I certify that the information provided is true and complete tot he best of my knowledge and that there is no intent to commit fraud or perjury; or I will be subject to immediate termination. I understand that the information provided will be used to determine eligibility for DREAMS program services and subject to review and verification, and taht I may be required to provide documents to substantiate income, benefits, prior and present work history, CDIB and other pertinent documentation to support this application. I further understand that a determination of eligibility is not a guarantee of services. I hereby authorize release of this information for verification purposed understanding all information is confidential and will not be released to any other agency, office, or individual unless the information is necessary to provide me with comprehensive services.
  • I certify I have reviewed the DREAMS Program Statement of Privacy

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