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REFERRAL FORM REFERRAL DATE: COMPLETED BY: PLEASE INDICATE SERVICES REQUESTED: Reemployment Services Reemployment Assessment Job Analysis Labor Market Survey Online Job Assistance CARRIER INFORMATION:
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Who needs please indicate services requested:

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Individuals seeking specific services from a service provider. This could include customers, clients, or patients who need to indicate their desired services for a particular service provider, such as a healthcare facility or a business offering various services.
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Employers or administrators who require employees or applicants to indicate the services they need. This could involve HR departments or managers who need to allocate resources or plan for specific services within a company or organization.
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Government agencies or organizations that provide multiple services to the public. They may use forms or documents asking individuals to indicate the services they are interested in, allowing for better resource allocation and service planning.
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The services requested are those that the individual or organization is asking for.
Any individual or organization that is requesting the services needs to file.
To fill out the services requested, simply provide the necessary information and details.
The purpose of the services requested is to specify what needs to be done or provided.
The information that must be reported depends on the specific services being requested.
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