Supported Employment Contract and Forms
Job Seekers Pages
Employment Support Services
OK Library for the Blind and Physically Handicapped
300 N.E. 18th Street
Oklahoma City, OK 73105
Office: (405) 522-2123
Toll Free: (800) 523-0288
Fax: (405) 522-2139
Right click pdf files to open in a new tab. Word, Excel and Zip files will download to your computer.
000c Sample FY 2025 Contracts.zip
Download: FY25 Final-Sample Contracts.zip
ESS-C-801 Authorization Request & Billing Form Rev 2024-08-01
Download: ESS-C-801 Authorization Request & Invoice Rev 2024-08-01
000fc All FY 2024 All Contracts All Forms Checklists (Official) (PDF)
Download: All FY 2024 All Contracts All Forms Checklists into single PDF file
FY 2025 Supported Employment Services Contract Sample PDF 2024-06-14
Download: FY25 Supported Employment Services Contract Sample 2024-06-14.docx
007f FY 2023 SE Forms (Official) ZIP File
Download: 007f FY 2023 SE Forms (Official).zip
007fc FY 2023 M0-SE Contract Forms Checklists (Rev 2022-09-14) ZIP File
Download: 007fc FY 2023 M0-SE Contract Forms Checklists (Rev 2022-09-14).zip
ESS-A-020 Incentive Payment Form (Rev. 2023-08-21)
Download: ESS-A-020 Incentive Payment Request Form (Rev 2023-08-21)
ESS-C-117 Travel Log and Invoice (Rev. 2024-03-06)
Download: ESS-C-117 Travel Log and Invoice (Rev 2024-3-06).pdf
ESS-C-133 DRS Counselor Monthly Update Form (Rev. 2021-08-11)
Download: ESS-C-133 DRS Counselor Monthly Update Form (Rev. 2021-08-11)
ESS-C-139 Situational Assessment Report (Rev. 2022-09-12)
Download: ESS-C-139 Situational Assessment Report (Rev 2022-09-12)
ESS-C-157 Pre-Placement Information Form (Rev 2023-11-27)
Download: ESS-C-157 Pre-Placement Information Form (Rev 2023-11-27)
ESS-C-161 (1) Job Analysis (Rev 2022-09-22)
ESS-C-161 (2) Job Analysis (Rev. 2022-09-22)
ESS-C-166 Job Development & Placement Report (Rev. 2023-12-08)
Download: ESS-C-166 Job Development & Placement Report (Rev 2023-12-08)
ESS-C-173 Team Meeting Report (Rev. 2022-09-12)
ESS-C-181 Termination & Re-Placement Report
Download: ESS-C-181 Termination & Re-Placement Report (Rev 2023-11-27)
ESS-C-185 Job Accommodation Form (Rev 2022-09-09)
ESS-C-213n O*NET median hourly wage documentation (for in-house placement only) (Rev. 2022-09-02)
Download: ESS-C-213n O*NET median hourly wage documentation (Rev 2022-09-02)
ESS-C-225 (1) Record of Hours Worked (Rev. 2021-09-23)
ESS-C-225 (2) Record of Hours Worked SE ST (HC) (Rev 2022-09-22)
Download: ESS-C-225 (2) SE ST (HC) Record of Hours Worked (Rev 2022-09-22)
ESS-C-225 (4) EM Record of Hours Worked (for EM 90-day Milestone) (Org 2022-09-22)
Download: ESS-C-225 (4) EM Record of Hours Worked for EM 90-day milestone (2022-09-22)
ESS-C-229 Natural Supports & Fading Plan (Rev 2023-08-09)
Download: ESS-C-229 Natural Supports & Fading Plan (Rev 2023-08-09)
ESS-C-233 Employment Verification Form (Rev 2022-09-21)
Download: ESS-C-233 Employment Verification Form (Rev 2022-09-21)
ESS-C-237n Current Pay Stub or Earnings Statement (Rev 2022-08-12)
Download: ESS-C-237n Current Pay Stub or Earnings Statement (Rev 2022-08-12)
ESS-C-249 Employee Satisfaction Survey (Rev. 2021-09-09)
Download: ESS-C-249 Employee Satisfaction Survey (Rev 2021-09-09)
ESS-C-253 Extended Services Statement (Rev. 2022-09-12)
Download: ESS-C-253 Extended Services Statement (Rev 2022-09-12)
ESS-C-266 Employment Outcome Report (Rev. 2022-09-13)
Download: ESS-C-266 Employment Outcome Report (Rev 2022-09-13)
ESS-C-278 Plan for Assessment (Revised 2022-09-12)
ESS-C-278n DRS Counselor Response to ESS-C-278 Plan for Assessment (Rev 2022-07-08)
Download: ESS-C-278n DRS Counselor Response to ESS-C-278 Plan for Assessment (Rev 2022-07-08)
ESS-C-289n Job Description (Rev 2020-02-25)
ESS-C-297 Compatibility Analysis (Rev. 2022-09-12)
ESS-C-297 Compatibility Analysis (Rev. 2022-09-12)
ESS-C-310 Assessment Milestone Report (Rev. 2022-09-12)
Download: ESS-C-310 Assessment Milestone Report (Rev 2022-09-12)
ESS-C-317n Copies of summary pages from vocational interest inventories (Rev 2022-09-08)
Download: ESS-C-317n Copies of summary pages from vocational interest inventories (Rev 2022-09-08)
ESS-C-321 Job Club Sign-in Sheet (Revised 2022-09-12)
ESS-C-325 Job Club Certificate of Completion (Rev. 2022-09-12)
Download: ESS-C-325 Job Club Certificate of Completion (Rev 2022-09-12)
ESS-C-338 R4 (4-weeks Employment) Milestone Report (Rev. 2023-08-09)
ESS-C-398 SE Authorization Request & Invoice Rev 2023-08-15
Download: ESS-C-398 SE Authorization Request & Invoice (Rev 2023-08-15).pdf
ESS-C-413 Highly Challenged Criteria Form (Rev. 2022-09-13)
Download: ESS-C-413 Highly Challenged Criteria Form (Rev 2022-09-13)
ESS-C-430 Stabilization Milestone Report (Rev 2022-09-12)
Download: ESS-C-430 Stabilization Milestone Report (Rev 2022-09-12).pdf
ESS-P-182 SE-SES Termination & Re-Placement Packet SE-SES (Rev 2022-09-21
Download: ESS-P-182 SE-SES Termination & Re-Placement Packet SE-SES (Rev 2022-09-21).pdf
ESS-P-M1-SE Packet (Rev 2022-09-23)
Download: ESS-P-M1-SE Packet (Rev 2022-09-23).pdf
ESS-P-M2-SE Packet (Rev 2022-09-23)
Download: ESS-P-M2-SE Packet (Rev 2022-09-23).pdf
ESS-P-M3-SE Packet (Rev 2022-09-23)
Download: ESS-P-M3-SE Packet (Rev 2022-09-23).pdf
ESS-P-M4-SE Packet (Rev 2023-03-09)
Download: ESS-P-M4-SE Packet (Rev 2023-03-09.pdf
ESS-P-M5-SE Packet (Rev 2022-09-23)
Download: ESS-P-M5-SE Packet (Rev 2022-09-23).pdf
ESS-P-M6-SE-HC Packet (Rev 2022-09-23)
ESS-P-M6-SE-REG Packet (Rev 2022-09-23)
ESS-P-M7-SE Packet (Rev 2022-09-23)
Download: ESS-P-M7-SE Packet (Rev 2022-09-23).pdf
