Valeo Vocation Intake Form

Contact Information

* Indicates Required Field

Do you have a Covid 19 Vaccination

Location

How did you hear about Valeo Vocation

Shelter Name

Valeo Employee Name

Flier Location

Referring Jail/Court/CCO

Other Referral Source

First Name

Middle Initial

Last Name

Date of Birth (MM/DD/YYYY)
Must be 18 or older.

SSN (###-##-####)

Preferred Address

If you do not have either a residential or mailing address, please see or contact Valeo staff.

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Preferred Phone

Phone Number

Preferred Email

Email Address

Emergency Contact Name

Emergency Contact Phone

Record Type

EMPLOYMENT

Valid Driver's License?

Is your license suspended?

How much is owed?

Do you have valid I9 documentation providing proof of legal authorization to work in United States? (Such as picture ID and social security card):

If NO what documentation do you need assistance obtaining before being placed on assignment

What type of employment are you looking for?

What type of industry do you want to work in?

Are you able to work full-time right now?

How many hours are you able to work?

Do you need any accommodations for work?

What accommodations are needed?

WORK HISTORY

1. What was your last place of employment

1. Was this placement via a temp agency

2. What was your last place of employment

2. Was this placement via a temp agency

Demographic Information

Do you own a vehicle?

Are you Head of Household?

Have you served in the Military?

Do you have a Disability?

Do you have Children?

How many children under the age of 18 in home

Are you currently receiving Food Stamps?

Monthly amount of food stamps

What is your level of Education?

What is your Gender?

Sexual orientation

Ethnicity

Race

Is English your first language

Level of English proficiency

Primary Language

Other Language

AGREEMENTS

Media Consent

Without expectation of compensation or other renumeration, now or in the future, I hereby give my contest to Valeo Vocation and its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising, or other media activities (including the internet and/or social media).

This consent includes, but is not limited to:

Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice.
Permission to use my name.
Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the internet), in theatrical media and/or in mailings for education and awareness.

This consent is given in perpetuity, and does not require prior approval by me.

Name

Date

Address

For Minors
The below signed parent or legal guardian of the above-named minor child hereby consents to and gives permission to the above on behalf of such minor child:

Signature of Parent or Legal Guardian

Date

Support Service Agreement

Valeo Vocation's mission is built on helping people reach self-sustainability. We do this by providing income opportunities through our staffing model and by working to identify career goals with participants. By accessing employment services through Valeo, you may receive support services to assist as you are reducing barriers to employment. Support services offered by Valeo vary and are determined by the information identified on your Bridge Assessment.

By signing this form, you acknowledge that support services are not a requirement of your participation with Valeo Vocation and may be suspended if the following conditions are not met:

Participant has proven a justifiable need for support service to assist in barrier removal.
Participant states all other options have been exhausted for needed support service and no other funds are available.
Participant will turn in any receipt, original gift card, or other documentation provided at point of purchase for approved expenditure.
Participant will utilize support service only for purpose discussed with and approved by Valeo staff.
Participant will not promote Valeo for the support service we are providing, as participant understands that these services are available only on a case-by-case basis.

Valeo understands that reducing barriers to employment may require a substantial amount of financial support. We hope that our staffing model can begin helping you earn the income you need to address your barriers, and our support services are meant to help as you begin reaching your goals. Please help us track the money we are spending to help you by communicating with staff, signing all documentation, and returning all gift cards and receipts.

Name

Date

Attendance Policy

As an employment agency with a goal of assisting participants onto a pathway of permanent, livable wage employment and stable housing, Valeo expects that all participants who engage in services are seeking full-time employment and are thus available for daily assignments, temporary assignments, temp-perm assignments and direct hire assignments. The following attendance requirements are expected of all Valeo participants.

Valeo participants are expected to be available for work daily, unless otherwise communicated with Valeo staff. If Valeo participants are unable to work a specific day they will directly express to a Valeo staff and will provide required documentation exempting them from work that day if prompted.
Valeo participants are required to accept positions offered to them, unless the position is unsuitable for the participant. Participants must report work restrictions at tie of enrollment and be willing to provide necessary documentation if prompted.
Valeo participants are required to be on time to work assignments. If a participants knows they will be late they are required to inform Valeo staff.
Valeo participants are expected to be at work when they are assigned a position. If a participant is unable to make it to an assignment, they are required to all in at least on our ahead of time but preferably the night before the assignment. One unexcused absence or "no call no show", is cause for termination and may result in such. NCNS may be excused if participant is able to provide reasonable explanation and necessary documentation. Having more than one unexcused absence is cause for termination.
Valeo participants are expected to be diligent in their communication efforts with Valeo staff.

Valeo Vocation is an at-will employer and reserves the right to terminate participants at any given time, with or without waring. As a service services agency, Valeo attempts to assist clients onto a pathway of self-sustainability and makes every attempt to be reasonable in expectations. If you have issues with any of the expectations, please discuss with Valeo staff.

Name

Date

Background & Drug Testing Policy

All Valeo participants must attend an orientation and complete an Initial Intake prior to program enrollment. Initial Intake will include a local and federal background check. Valeo participants understand that it is Valeo's policy to run a criminal background check on all individuals who are enrolled. An additional criminal background check and drug testing may be required prior to being offered any work assignment.

Valeo's background policy requires that no individual have any type of sex crime on their background but does not deem any other charge as an automatic denial of employment; however some charges may result in denial of certain positions. Valeo will take all charges into consideration when matching candidates with job assignments and will attempt to offer job assignments to all participants, regardless of criminal background and with adherence to customer contract requirements.

Some customers require drug testing as part of their contract with Valeo. Valeo will uphold this requirement and will require drug testing to be conducted prior to assignment. Valeo participants understand that unsatisfactory results will result in termination from customer assignment but may not necessarily result in termination from other Valeo assignments. Valeo expects that all clients will be transparent in communicating their level of drug use to Valeo staff prior to job placement. Federal guidelines prohibit marijuana consumption during positive employment and Valeo will adhere to these guidelines for customers that require drug testing. Testing positive for marijuana will result in job termination.

Valeo Vocation follows federal guidelines regarding accidents sustained during the course of any job assignment. Any accident resulting in injury incurred will automatically require medical attention and a drug test will be conducted. Accident investigation will include interview and written statement from onsite supervisor as well as effected Valeo participant. Valeo participants agree to submit to medical attention and accident investigation within 24 hours of the time injury was sustained. 

Valeo maintains the right to conduct random drug testing at any given time during client participation in programming. The Valeo program model encompasses employment barrier reduction and recognizes that drug use has a negative impact on positive employment. Valeo staff work with clients to move towards positive employment and maintaining a self-sustaining, drug-free lifestyle.

Name

Date