This Sample Forms section, includes a variety of forms that could be used to document HVRP practices. The presentation of these forms does not mean NVTAC or US DOL-VETS endorses any particular form as required, or as an approved form. These forms were collected from service providers and are only intended to help program planners develop forms and tools that will serve the needs of their program.
The forms this section are samples for your perusal and information. If program planners would like to use or modify any of these forms for their use, we encourage you to do so.
Intake and Assessment Forms
– Assessment Sheet A preliminary assessment sheet, to gather general information from client
– Determining Readiness for Employment Utilize this form in order to determine how ready an individual is, for employment.
– HVRP Eligibility Assessment Form Is your client eligible to receive HVRP benefits? Find out by completing this form.
– HVRP SSVF Employment and Education Assessment Assess your clients HVRP/SSVF employment eligibility, and educational history.
– Supportive Service Needs Checklist This Checklist will help you to determine what the primary needs of the client are.
– Veterans Work Program Intake Application Assessment Is your client eligible for the Veterans Work Program?
– Vulnerability Index and Services Prioritization Decision Assistance Tool (VI-SPDAT) The VI-SPDAT tool is helpful in prioritizing the needs of the client.
Homeless Certification Forms
– Homeless Certification Intake Counselors utilize this form to verify and confirm that a client is homeless.
– HPRV Documenting Veteran and Homeless Status Another form that can assist you in documenting a Veterans Homeless status.
– HVRP Self Attestation Form A form for clients to fill out, to declare their homeless status.
Participant Agreement Form
Individual Employment Plan (IEP) Forms
– Adult Dislocated Worker Employment Plan This form will assist Case Manager or Intake counselor in determining the physical limitations of their client.
– Adult Dislocated Worker Training Plan A cohesive and practical tip to assist staff/agency personnel in developing a training plan.
– Employment History This form will provide an extensive look into the Employment history of the client.
– Individual Employment Plan Collaborate with your client, and create a custom made employment plan.
– Inventory of Employment Training Issues An additional form that is useful to assess past employment and training experience.
– Overcoming Identified Barriers/Needs Determine needs for service and/or training with this form.
– Veterans Services Individual Employment Plan A template for a client Employment Plan.
Job Retention Forms
– Employment Verification Form Use this form to collect client employment verification information.
– Employment Verification Additional Employment Verification form.
– Job Retention Proposal An agreement between client and job developer focusing on job retention plans.
– Monthly Job Placement/Retention Progress Report Is the participant actively participating in their retention process?
Progress Notes Form
Client Folder Organization Forms
– Enrollment instructions for HVRP Folders Utilize this checklist to prepare HVRP Folders.
– Folder Make up Instructions for Logging In and Placing Documents Utilize this checklist for logging all documents and information.
– Assessing Job Traits and Matching Occupations Important form for Case Managers to utilize.
– MHVRP Program Referral for Services Form A referral form for Veteran clients.
– HVRP Service Satisfaction Survey Helps provide quallity employment information from the vereran point of view. This form is required to be completed by the veteran at placement or retention.
– Monthly Budget Monthly financial planning template.