• Orientation Acknowledgement

    Welfare-to-Work Orientation Acknowledgement

    • Did you watch the entire video? Yes No
    • Did you download the Welfare-to-Work hand book or would you like one mailed to you?
    • Do you understand that if you have any questions, you can call your Case Manager anytime during normal business hours? Yes No

    Certification Message

    By submitting this form I certify that,

    I understand that the purpose of Welfare-to-Work is to help me prepare for work and find a job.
    I have watched the Welfare-to-Work Orientation video and understand my Rights and Responsibilities.
    I viewed and/or downloaded or requested a copy of the Welfare-to-Work Handbook.
    I know that I have certain rights and responsibilities as a participant in Welfare-to-Work.
    I know that I must meet all my responsibilities as a Welfare-to-Work participant.
    If I fail to meet my responsibilities without good reason, I know that there are certain penalties and that my cash aid may be affected.


    * By checking this box, you agree to the use of electronic signatures. This will have the same legal effect as delivery of an original executed copy of this form for all purposes.