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Quest WORKS Accelerator Application Applications must be submitted no later than March 30, 2020

Have an interest in interning in the medical/hospital setting

Have a desire to reach competitive employment in an entry-level position

Met all credits for graduation and have received their diploma (Public or Private schools) or has exited the school system

Be 18 years or older

Be a client (or in process) of Vocational Rehabilitation; met all eligibility requirements

Previous experience in a work environment preferred (job training, internship, volunteer and/or paid work)

Complete Internship Application and participate in an interview/trial class at a Quest facility

Maintain appropriate behavior, social skills and daily living skills required by the site

Able to pass a background check and be tobacco/smoke and drug free

Hospital Site: Up-to-date immunization records, TB testing, Flu Shot

Provide state ID, social security card (not laminated) and proof of medical insurance

Participate in travel training while enrolled in the Internship Program (Access Lynx, public transportation, own car, etc.) as needed

Desire and plan to work in a competitive employment role by the end of the Internship Program

Maintain an open schedule for employment which matches an entry-level position

The Internship Program is from September to December (Fall Semester). It is a 4-month paid training program.

Interns are responsible for their own roundtrip transportation from their home to the host site (travel training will be provided as needed).

Upon hire, interns will continue to receive supported employment services through Quest, Inc. and Vocational Rehabilitation. Interns will need to use their chosen form of transportation to reach their employment site (Access Lynx, City Bus, Parent, etc.).

Internship Program goals are to select Trainees who…

Internship requirements and acceptance criteria:

Internship Program Description

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Competitive Employment is work performed by a person with a disability within an integrated setting with supports which naturally occur in the work environment. Wages are at least minimum wage or higher and at a rate comparable to non-disabled workers performing the same tasks.

Entry-level Job are jobs at the introductory level. Many entry-level jobs are part-time and do not include employee benefits and will often require employees to work evenings, weekends and holidays. Most interns seek employment in businesses that operate 24 hours, 7 days a week.

Part-time Job are jobs that often require 16-39 hours per week. Most interns are placed in part-time jobs where they work an 8-hour shift, 3 or 4 days a week. It is uncommon to find part-time employment of 4-5 hours a day, 5 days a week.

Applicant Name: _______________________________________________ Date of Birth: ___________________

Phone: ___________________________________ Alternate Phone: ____________________________________

Email: ___________________________________________ Primary Language: ____________________________

Address: _________________________________________________________________________________________

City: ____________________________________ State: _______________ Zip Code: _____________________

Parent/Guardian Name: ____________________________________________________________________________

Phone: ___________________________________ Alternate Phone: ____________________________________

Email: ___________________________________________ Primary Language: ____________________________

Address: _________________________________________________________________________________________

City: ____________________________________ State: _______________ Zip Code: _____________________

How did you hear about us? _________________________________________________________________________

Hands-on training to acquire desired skills are offered through rotations at our Host site.

Food Service – cold food prep, lobby attendant, dishwasher/steward

Guest Room Attendant – housekeeping, cleaning, sanitizing, trash removal

Guest Services (also includes patient services) – assisting guests and visitors

Job Placement Information

Internship Application – Contact Information

Training Skills (check all skills you are interested in learning during your internship)

Last First M.I.

Last First M.I.

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Work Experience #1: Employer: _______________________________________________ Unpaid Paid

Job Duties: ________________________________________________________________________________________

Work Experience #2: Employer: _______________________________________________ Unpaid Paid

Job Duties: ________________________________________________________________________________________

Work Experience #3: Employer: _______________________________________________ Unpaid Paid

Job Duties: ________________________________________________________________________________________

Have you ever been removed from job training, volunteering or fired from a paid employment position? Yes No

What is your entry-level job interests? (check all job areas that interest you)

Hospital Hotel Retail / Grocery Theme Parks

What is your transportation plan during internship and upon hire? (check all that apply)

Access Lynx City Bus Parent/Family/Friend Uber/Lyft Walk/Bike Drive

What is your preferred work schedule (after you are hired)?

Hours per week: _________________ Times: ____________________ Days: __________________________

**It is important to note that morning and early afternoon shifts are extremely rare. For the best results, late afternoon and evening availability including weekends and holidays are recommended.**

Are you a client of Vocational Rehabilitation (VR)?

Yes, I have a completed Individualized Plan for Employment/IPE with VR

In Process: ___________________________________________________________________________________

If Yes or In Process, VR Counselor Name: _________________________________________________________________

No, I have not contacted VR or completed a referral

Are you a client with Access Lynx? Yes In Process: ____________________________________ No

Are you a client of Agency for Persons with Disabilities (APD)?

Yes In Process: ____________________________________ No

If Yes or In Process, APD Support Coordinator Name: _______________________________________________________

Do you receive Supplemental Social Security Income (SSI)? Yes Amount: _______________ No

Do you receive Social Security Disability (SSDI)? Yes Amount: _______________ No

Is this a Survivor Benefit? Yes No

Check if you receive any of the following:

Medicaid Medicare Food Stamps Public Assistance Other disability related benefits Ticket to Work

Work Experience (job training, volunteer or paid employment)

Job Placement Questionnaire

Service Agencies Information

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List all medications which are taken routinely: __________________________________________________________

_________________________________________________________________________________________________

Are any medications taken between the hours of 9:00am-3:00pm? Yes No

List any health or medical limitations that may impact internship training or successful job placement: ____________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Do you have any behaviors that might impact internship training or successful job placement? Yes No

If yes, please explain: ________________________________________________________________________

Have you ever been arrested? Yes No

If yes, please explain: ________________________________________________________________________

I understand that I must have the desire to gain competitive employment in an entry-level position and maintain open availability requirements for entry-level positions to participate in this program.

I will follow all the rules and regulations established by the program and all of the associated partners.

I understand that career placement will be made without regard to race, color, national origin, gender, age, religion or presence of a disability.

By signing below, the applicant and parent/guardian agrees to comply with procedures, rules and requirements.

Applicant Signature _______________________________________________ Date __________________________

Parent/Guardian Signature _________________________________________ Date __________________________

Send completed applications via email to: Quest, Inc. ATTN: Mindy Nguyen 1509 E. Colonial Drive Suite 300 Orlando, FL 32803 Email: Minh.Nguyen@questinc.org Phone: (407) 317-5416 Fax: (407) 218-4301

Independent Living and Behavioral Summary

Parent/Guardian & Student Agreement Information