Employment Services Application

Completing the online application is the first step toward realizing your goal of returning to work and reducing your dependency on benefits. Simply answer each question and submit the form. Once we receive your responses in our office, they will be reviewed and evaluated. A staff person from RAMP EN will follow-up with you to discuss your answers and, if appropriate, to continue the process. If it is determined that you are a good candidate for our program you will be invited to attend a program orientation where we will discuss more about the Ticket to Work, how your benefits are impacted by working and earning income, and share with you more about our program and the services we can offer to you.

RAMP EN considers a number of factors when determining whether to accept a ticket from someone. Motivation, sincerity and attitude on the part of the ticket holder are a primary factor in this decision. RAMP EN also considers work history, the qualifications that the candidate has for the occupation they are seeking to enter and if the services we offer will meet the needs of the ticket holder.

THIS IS NOT AN APPLICATION FOR PERSONAL ASSISTANT/INDIVIDUAL PROVIDER EMPLOYMENT. If you are interested in that field please contact your local RAMP office to find out how.

Personal Data


Date Last Worked

Date of Birth

Are you currently working with RAMP CIL Employment Services?

 YES NO

Have you ever been convicted of a felony?

 YES NO

If yes, please explain:

What services do you feel you will need as you seek work?

What are your career goals? (type of job you are seeking)

Salary Expections:

Total hours available per week:

I would like to work: (choose all that apply)

 Full Time Part Time Temporary Contract

Does your disability limit the type of work you can do?

 YES NO

If yes, please explain:

What is your disability and how does it limit your ability to work?

Monthly amount of your Social Security Benefit:

• SSDI

• SSI

Other sources of income:

• Long Term Disability

• Workman's Comp

• Other

Do you have a valid Driver's License?

 YES NO

Do you have a working vehicle?

 YES NO

If no, how will you get to work?

High level of education:

Field of special training or college degree:



Employment History


If you have ever been terminated from a position, please explain


In the space provided, please list the last 3 positions you held. Additionally, you may send your resume if you have one.


Employer Name

Position / Job Title

From To

Responsibilities

Reason for leaving



Employer Name

Position / Job Title

From To

Responsibilities

Reason for leaving



Employer Name

Position / Job Title

From To

Responsibilities

Reason for leaving



Please explain any gaps in your work history


Additional comments



Thank you for completing the Employment Services Application. Please review your answers. Once you are comfortable with your answers, hit submit to send the application.