WorkAbilityUCPSA Member Application 
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  • WorkAbilityUCPSA Member Application/ Solicitud de miembro de WorkAbility

    WorkAbilityUCPSA Member Application/ Solicitud de miembro de WorkAbility

    Providing individualized training and employment for people with disabilities/ Proporcionar formación individualizada y empleo para personas con discapacidad
    • Basic Information/ Información básica 
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    • Personal Information/ Informacion personal 
    • Who is your legal guardian?/ ¿Quién es tu guardián legal?*
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    • Over 18 Years old/ Mayores de 18 años
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    • Rows
    • Is there an EPI pen/ ¿Hay una pluma EPI??
    • Any Seizures/ Cualquier convulsión:
    • Any Assistive Devices? (Wheelchair, Walker, etc.)/ ¿Algún dispositivo de asistencia? (Silla de ruedas, Andador, etc.)
    • Any Vision or Hearing Devices? (Glasses, Contacts, Hearing Aids, etc.)/ ¿Algún dispositivo de visión o audición? (Anteojos, Contactos, Audífonos, etc.)
    • Any other health concerns?/ ¿Algún otro problema de salud?
    • Have you ever been arrested or convicted of a crime?/ ¿Alguna vez ha sido arrestado o condenado por un delito?*
    • Additional Information/ Información Adicional 
    • Which of our services are you interested in? To learn more about the services below, visit our website www.workabilityucpsa.org. Check all that apply/ ¿Cuál de nuestros servicios te interesa? Para obtener más información sobre los servicios a continuación, visite nuestro sitio web www.workabilityucpsa.org. Marque todo lo que corresponda*
    • Have you ever received employment services before?/ ¿Alguna vez ha recibido servicios de empleo antes?*
    • Rows
    • Do you have transportation?/ ¿Tienes transporte?*
    • If No, are you willing to obtain or learn transportation skills?/ Si la respuesta es No, ¿está dispuesto a obtener o aprender habilidades de transporte?*
    • Academic Background/ Antecedentes Académicos 
    • Are you still in high school?/ ¿Todavía estás en la escuela secundaria?*
    • If No, have you completed high school or a GED?/ Si la respuesta es No, ¿ha completado la escuela secundaria o un GED?
    • Are you attending college?/ ¿Estás asistiendo a la universidad?*
    • Are you planning on attending college?/ ¿Estás planeando asistir a la universidad?*
    • Have you been employed or volunteered before?/ ¿Ha sido empleado o voluntario antes?*
    • Employment/Volunteer History/ Historial de empleo/voluntariado 
    • List Employers/Volunteer sites (begin with the most recent Employer/Volunteer)/ Enumere los sitios de empleadores/voluntarios (comience con el empleador/voluntario más reciente)

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    • Do you have another employer?/ ¿Tienes otro empleador?
    • Second Employment/Volunteer/ Segundo empleo / voluntario 
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    • Personal References/ Referencias personales 
    • The WorkAbility program requires three personal references. These could be from friends, previous employers, teachers or other team members./ El programa WorkAbility requiere tres referencias personales. Estos pueden ser de amigos, empleadores anteriores, maestros u otros miembros del equipo.

    • Reference #1/ Referencia #1

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    • Reference #2/ Referencia #2

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    • Reference #3/ Referencia #3

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    • Referral Information/ Información referencial 
    • Do you receive Vocational Rehabilitation (Voc Rehab/VR) services?/ ¿Recibe servicios de rehabilitación vocacional (Voc Rehab/VR)?*
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    • Do you receive services through the Division of Developmental Disabilities (DDD)?/ ¿Recibe servicios a través de la División de Discapacidades del Desarrollo (DDD)?*
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    • Preferences and Skills/ Preferencias y Habilidades 
    • Do you prefer doing activities/ Prefieres hacer actividades:*
    • Do you prefer to do activities/ Prefieres hacer actividades:*
    • Are you able to lift 25lbs?/ ¿Eres capaz de levantar 25 libras?*
    • Do you have the ability to stand or sit for an hour?/ ¿Tiene la capacidad de pararse o sentarse durante una hora?*
    • Are you able to do activities in highly stimulating environments (noisy, busy, lots of people)?/ ¿Eres capaz de realizar actividades en entornos muy estimulantes (ruidosos, ocupados, con mucha gente)?*
    • How do you communicate?/ ¿Cómo te comunicas?*
    • Are there any speech difficulties?/ ¿Hay alguna dificultad en el habla?*
    • Choose potential job/volunteer site(s) that you would like to explore/ Elija sitios potenciales de trabajo/voluntariado que le gustaría explorar:*
    • Program Information and Requirements/ Información y requisitos del programa 
    • Are you safe to yourself and others?/ ¿Estás seguro para ti y para los demás?*
    • Are you able to get yourself back and forth to sessions or class/workshops?/ ¿Es capaz de ir y venir de las sesiones o clases/talleres?*
    • Are you willing to be on time to your sessions? /¿Estás dispuesto a llegar a tiempo a tus sesiones?*
    • Are you willing to be on time to a future job or to volunteer?/ ¿Estás dispuesto a llegar a tiempo a un trabajo futuro o ser voluntario?*
    • Are you able to follow the hygiene requirements of this program?/ ¿Puede seguir los requisitos de higiene de este programa?*
    • Check all the requirements you can follow/ Consulta todos los requisitos que puedes seguir:*
    • What is this?

      The Work Opportunity Tax Credit (WOTC) is a Federal tax credit available to employers for hiring individuals from certain target groups who have consistently faced significant barriers to employment.

      How does this benefit me?

      WOTC helps qualified job seekers obtain employment by offering an incentive to employers who are considering hiring them. Qualified job seekers include vetrans, TANF recipients, SNAP (Food Stamps) recipients, Vocational Rehabilitation participants, ex-offenders, SSI recipients, and individuals who live in certain low income communities. You may opt-out if you do not wish to participate.

    • Are you under 40?/ ¿Tienes menos de 40?
    • Are you willing to arrive on time for your sessions?/ ¿Estás dispuesto a llegar a tiempo a tus sesiones?*
    • Are you a Veteran?/ ¿Eres un veterano?*
    • Received TANF cash assistance in the last 6 months?/ ¿Recibió asistencia en efectivo de TANF en los últimos 6 meses?*
    • Have received SNAP (food stamps) in the past 6 months?/ ¿Ha recibido SNAP (cupones de alimentos) en los últimos 6 meses?*
    • Do you have a disability?/ ¿Tienes alguna discapacidad?*
    • Summer Youth Program/Ticket to Work?/ ¿Programa de Verano para Jóvenes/Boleto para Trabajar?*
    • Do you receive SSI/SSDI?/ ¿Recibe SSI/SSDI?*
    • The WorkAbility program has the following requirements/ El programa WorkAbility tiene los siguientes requisitos 
      • Be willing to be motivated and work
      • Participate in activities and job seeking
      • Show up to scheduled sessions consistently.  (If you miss 3 consecutive sessions without a phone call, you will be put on probation and a team meeting will occur to assess if you are truly serious about employment.)
      • Arrive on time to appointments, meetings, and employment sessions
      • Treat people on your employment team with respect
      • Look presentable and clean:
        • Job seekers need to have clean clothes, clean bodies, clean teeth, clean nails, and smell good. Employers are looking for these qualities when hiring
      • Communicate regularly:
        • Call job/volunteer site if you cannot make your scheduled shift and then call the WorkAbility number – 520-344- 8250  so that we can cancel the Employment Specialist 
      • Be flexible:
        • There is no guarantee that the WorkAbility program will find immediate employment for its job seekers – It takes time to find a good match. We do not have jobs sitting around waiting for you. It is a process
        • There is no guarantee that the job seeker will have the same job site for any length of time – they may have multiple sites. The job seeker may be transitioned to other sites based on his or her progression, development of skills, or the job seeker may want to choose a different employment opportunity
        • We will do our best to find a match. The job seeker may need to intern or volunteer for a period of time in order to gain "hands on"  skills

      Natural Consequences for not following the requirements of the WorkAbility employment services program:

      • Verbal warning
      • Probationary period – given time to rectify issues
      • No placement
      • Asked to leave the program
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    • Should be Empty: