Authorization to Refer Individuals for Job Placement
Date
: 11/21/2024
Client Information
First Name
*
:
Last Name
*
:
M.I. :
Last 4 of SSN
*
:
I authorize CareerSource Palm Beach County to refer me to jobs for the purpose of assisting me with finding employment. This authorization shall be in effect for a period of one (1) year from the date of my signature below.
*
By typing your name below, you agree that will be used as your signature.
Signature(Enter your full name)
*
:
Date
*
:
Login
