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.
Name *
Name
Date of Birth
Date of Birth
Phone
Phone
According to your State's Vocational Rehabilitation agency standards, is your disability categorized as significantly disabled? *
Have you been a participant of any State Vocational Rehabilitation or program?
$
Please specify what hours you are willing to work:
Best time to contact:
Best time to contact: