Cares of Washington Application Form

Please fill out the following form to the best of your ability. We are just looking for basic information about you or the individual in need. When finished, click the Submit button, and someone from Cares will contact you within two business days (Saturday and Sunday excluded). If you are unable to finish the form, the information provided will have to be entered again on your next visit.

In order to be eligible for any Cares employment programs, one or more of the following must be applicable to you (or the individual you are applying on behalf of):

  • Individual with a disability and are currently unemployed
  • Currently receiving or have received SSI (Supplemental Security Insurance) or SSDI (Social Security Disability Insurance)
  • Have been a claimant with Labor and Industries or Workers Compensation
  • Have a learning disability (or may have that is currently not diagnosed)
  • Have received services from Vocational Rehabilitation services including DVR (Division of Vocational Rehabilitation) or DSB (Division of Services for the Blind)
  • Have received drug and alcohol treatment
  • Had a stroke, HIV, mental disability, or any other form of physical or mental disorder.

Basic Information
  1. According to your State's Vocational Rehabilitation agency standards, is your disability categorized as significantly disabled? *
  2. Have you been a participant of any State Vocational Rehabilitation or program? *
  3. Do you or have you ever received SSI or SSDI benefits? *
Past Employment History
  1. If you have a resume, attach it here. It must a .pdf, .doc or .docx file. If you do not have a resume, fill out the Work History and Education text boxes below.
  2. Please specify what hours you are willing to work: [Check all that apply] *
  3. Transportation available to you: *
Optional Questions
  1. The following questions are optional. They are useful to CARES of Washington for Equal Employment Opportunity reporting compliance, and are not considered as part of your application and are not related to your eligibility.
  2. Have you ever been in a union?
  3. Sex
  4. Marital Status