JOB PLACEMENT AND RETENTION REPORT
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Vocational and Educational Services for Individuals with Disabilities (VESID)
Special Education and Vocational Rehabilitation Services

• Employer:
  
  
  
• Employer Address:
  
  
  
  
  
  
• Employer Telephone #:
  
  
  
• Contact Person:
  
  
  
• Job Title:
  
  
  
• Job Duties:
  
  
  
  
  
  
• Date Employment Started:
  
  
  
• Hourly Rate of Pay:
  
  
  
• Number of Hours per Week:
  
  
  
• Health Benefits? Yes or No