Online Placement Report Form by Coalition | Apr 12, 2021 | Form | 0 comments Placement Form Client Name* VR Case Number VR Case Status Open Closed Gender* Female Male Race* Black White Asian Multiracial Veteran* Yes No Client's Home ZIP Code* Primary Disability* Secondary Disability Education Level*No Diploma/GEDHigh School Diploma/GEDSome College (no degree)Certificate (non-degree)Undergraduate DegreeGraduate DegreeEmployer*Allied UniversalAmazonBest BuyBright SpringsCompass/EURASFedExGeek SquadGoodwillHJI, Inc.HumanaJCPSKeen ShoesKrogerLG&EMasonic HomeNortonParallonRev-A-ShelfSalvation ArmySeven CountiesSpectrumUPS-WorldportUPS - Supply ChainUPS WTLCWalgreensWalmartOther (please note below)Other Employer Job Title* Start Date* MM slash DD slash YYYY Hours Per Week* Job Duties* Wage* Job Type* Training Temporary Permanent Part Time Permanent Full Time Benefits* None After 30 Days After 60 Days After 90 Days Other Other Benefit Eligibility VR Counselor* Employment Specialist* Agency Name* Email Address of Person Submitting Form*
