Stamped
Received Social Security
10-19-1998
Gainesville,
Fl
JOBS AND BENEFITS WORK REGISTRATION REFERRAL
Date of
Referral to Jobs and Benefits: 10-14-1998
Application X
Checked: Food
Stamps Only
Name: Christopher Walters Social Security Number: 261-90-6357
Florida Request For Assistance Or Case Number 1008416339
Federal Regulations mandated that, unless exempt, you must register for work as a condition of eligibility for receiving public assistance. To register for work, you must take this referral to the Department of Labor, Jobs, and Benefits Service Center listed below and have a represenative complete "Section B". You return this completed referral to the Economic Self-Sufficency Office at the time of your eligibility interview or prior to being approved for public assistance.
Jobs and Benefits Service Center located nearest you is:
Gainesville Employment
Service Center
4800 SW 13th Street
Gainesville, Fl
32608
(352-955-2245)
I understand that unless exempt, I must register for work at the Jobs and Benefits Service Center to be eligible to receive public assistance. My Opportunities and Obligations for participatin have been explained to me, I understand them and a copy has been provided to me.
Chris
Walters
Oct 14, 1998
Applicant
Signature
Date Signed
Oct 14, 1998
Agency Represenative
Signature
Date Signed
Verneita
Patterson
(352-334-1654)
Print Agency
Represenative
Name
Telephone Number
Section B:
Dated Registered for Work : 10-14-1998
Job Referrals
Given Yes No X
Potentially Eligible for
Unemployment Compensation NO X
Unemployment
Compensation Application Completed NO X
Comments: "Diseased
Bowel" Infectious
Unlegible
10-14-1998
Jobs and Benfits
Represenative Signature
Dated Signed:
Unlegible
`
(954-5054)
Print Jobs and Benefits
Represenative Named Telephone Number
We Will Consider Your ApplicationWith Regard To Race, Color, Sex, Age, Handcap, Relgion, National Origin, Political Belief, or Marital Status
Form: Referral Doc 1/6/97bla