Authorization to Refer Individuals for Job Placement
Date
: 04/24/2024
Client Information
First Name
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Last Name
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M.I. :
Last 4 of SSN
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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.
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By typing your name below, you agree that will be used as your signature.
Signature(Enter your full name)
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Date
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