Form
The Representative - Men's Closet Client Referral Form
Providing professional attire, interview prep, and career coaching.PLEASE COMPLETE AND SUBMIT FORM FOR EACH CLIENT. WE WILL CALL THE CLIENT TO SCHEDULE AN APPOINMENT. WE CANNOT GUARANTEE SAME DAY APPOINTMENTS. Client must be actively job searching or has recently obtained a job to receive professional attire. We do not carry casual items. You may need to call the client to obtain information needed such as their sizes.
Part One - Agency Information
Agency name
Contact Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Part Two - Client Information
Name
First Name
Last Name
Date of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Type of Transportation
Please Select
I have transportation
I can get a ride to and from
I do not have any means of transportation
Highest Level of Education
Please Select
Highschool grad/GED
Some college
College degree
None
Does Client Receive Public Assistance
Yes
No
In process of
Is The Client A Veteran
Yes
No
Has The Client Been Previously Incarcerated
Yes
No
Part Three - Client Clothes Sizes
Top/Shirts
Pants
Shoes
Height
Weight
What Is The Client Needing. Choose All That Apply
Interview Clothing
Current Job Clothing
Court Appearance
Returning Client - Hired!
Interview Date
Job Hire Date and Type of Work
List Any Additional Information That Would be Helpful to Us Serving Your Client.
Submit
Should be Empty: