"30, 60, 90 Day Verification of Successful Employment and Job Retention" - Nevada

30, 60, 90 Day Verification of Successful Employment and Job Retention is a legal document that was released by the Nevada Department of Employment, Training and Rehabilitation - a government authority operating within Nevada.

Form Details:

  • Released on November 1, 2018;
  • The latest edition currently provided by the Nevada Department of Employment, Training and Rehabilitation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Employment, Training and Rehabilitation.

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Download "30, 60, 90 Day Verification of Successful Employment and Job Retention" - Nevada

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State of Nevada Bureau of Vocational Rehabilitation
30, 60, 90 Day Verification of Successful Employment
and Job Retention
☐ 60 DAYS
☐ 90 DAYS
☐ 30 DAYS
Participant:
Counselor:
Employer/Address:
Supervisor/Manager:
Work Phone:
Job Title:
Rate of Pay:
Hours per Week:
Start Date:
Today’s Date:
Health Insurance Benefits:
Yes
No
Participant/Representative Signature:
Date:
Job Developer Signature:
Date:
Supervisor/Employer Signature:
Date:
(Provide supplementary report or continue on new page if more space is required)
List any issues or concerns that may need to be addressed
Date
Time
Method
Spoke/Met
Result
Consistent Contact is Required
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
Form and a copy of the participant’s most recent paystub (if this form is not signed by the employer) to be submitted with
each bill for payment of successful employment progress. Please submit the completed form to the Business Development
Team at businessdevelopment@detr.nv.gov
November 2018
State of Nevada Bureau of Vocational Rehabilitation
30, 60, 90 Day Verification of Successful Employment
and Job Retention
☐ 60 DAYS
☐ 90 DAYS
☐ 30 DAYS
Participant:
Counselor:
Employer/Address:
Supervisor/Manager:
Work Phone:
Job Title:
Rate of Pay:
Hours per Week:
Start Date:
Today’s Date:
Health Insurance Benefits:
Yes
No
Participant/Representative Signature:
Date:
Job Developer Signature:
Date:
Supervisor/Employer Signature:
Date:
(Provide supplementary report or continue on new page if more space is required)
List any issues or concerns that may need to be addressed
Date
Time
Method
Spoke/Met
Result
Consistent Contact is Required
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
☐ Text/Email
☐ Employer
☐ Telephone
☐ Participant
☐ Job Site Visit
☐ Other:
☐ Other:
Form and a copy of the participant’s most recent paystub (if this form is not signed by the employer) to be submitted with
each bill for payment of successful employment progress. Please submit the completed form to the Business Development
Team at businessdevelopment@detr.nv.gov
November 2018