Case Name:	Case DCN/User ID:	Staff Name/ID:
Reviewed By:	Review Date/Type: ☐ Monitoring ☐ Targeted ☐ Other	Review Period:
Enrollment: N/A Verification of SSN, age, citizenship, and selective service registration in file N/A Documentation of family size and participant role (parent or child living w/parent or caretaker) N/A Income eligibility entered in MoJobs or documentation of FSD verified TANF/SNAP case in file N/A Enrolled in MoJobs within one week if application completed by paper N/A SNAP participant co-enrolled in SkillUP (if not returning to school or will not enter fulltime employment) Notes:
Participant Assessment: N/A Orientation completed N/A Participant linked to other community organizations with job market and employer connections N/A Information provided and referral made to AEL (if no HS diploma or equivalent) N/A Work readiness/training information provided prior to placement (if not included in orientation) N/A Assessment completed prior to placement in any activity N/A Checklist used to ensure all steps completed Notes:
Case Notes: N/A Mandatory Initial case note entered and contains required information N/A DWD Statewide Service Notes policy followed (see handbook for guidance) N/A Present for any supportive service N/A Present for any activity or service provided, including actions outside of MoJobs system N/A Entered at time of contact Notes:
Objective Assessment Summary: N/A Outlines desired employment, type of employment, and expected hourly wage N/A ONET and LMI reviewed if desired employment is not known N/A Training/education required for desired position is listed N/A All employment barriers sections are completed, with comments to address Notes:
Individual Employment Plan (18-24 year olds): N/A Includes steps to remove barriers N/A Connects services to desired outcome N/A Minimum one short-term & one long-term goal, not the same goal, with employment as final goal N/A Minimum of one objective per goal, not the same as the goal and has timeframe for completion N/A Updated with any changes Notes:
Supportive Services: N/A TRE/WRE provided to remove or reduce barriers to allow participation in Jobs League activity If yes: N/A Other resources explored and documented N/A Justification noted and need demonstrated to allow participation in Jobs League activity Notes:
Contact: N/A Biweekly contact with participant and if applicable, with employer N/A Minimum of one monthly face-to-face with participant and if applicable, with employer Notes:
Outcomes: N/A Contact attempted or completed for exited participant for four quarters If yes,MoJobs reflects: N/A Employment gained N/A Credentials/certificates obtained N/A Short-term training completed N/A Enrolled in or completed post-secondary education Notes:
Reviewer Comments/Recommendations: