New Client Intake Form / Terms & Conditions - Telehealth / Online

  • Supported Employment Department Pre-Screening Form

    Thank you for your interest in our employment services. We’re excited to learn more about you and to help you achieve your career goals! This pre-screening form is the start of us better understanding your unique skills, interests, and any specific support you may need along the way. Completing it should only take about 10-15 minutes, and each question helps us tailor our services to best suit your needs. Once you’ve submitted the form, our team will review your information, and we’ll reach out within 3-5 business days to discuss next steps and get you started on your path to success. We look forward to working with you!
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  • Would you prefer for us to contact you by:*
  • Martial Status:*
  • Current Employment:*
  • Have you ever been a customer of Texas Workforce?*
  • Have you had any prior work experience?*
  • Are you looking for fulltime or part-time employment?
  • Do you receive SSI or SSDI?*
  • Do you have reliable transportation?*
  • If you could have any superpower to help you succeed at work, which would you choose and why?

  • General Service Agreement

  • Is it your statement that you have answered and completed all questions in a truthful and honorable manner?*
  • I accept to be contacted by Reaching Maximum Independence by text and email regarding appointment reminders.*

  • I have read and understood this Intake Form, and agree to the above conditions for being interested in receiving services from Reaching Maximum Independence.

  • Thank you for choosing Reaching Maximum Independence to support you in your employment journey. If you have any questions, please do not hesitate to contact the Director of Supported Employment via email - ses@rmihomes.org

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