Training and Employment Program

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TRAINING AND EMPLOYMENT PROGRAM

1. File number(

)..

Date().
2. Name().
3. Age( ).. Sex( ).
4. Education details( ) ...
.
5. Full address( )
.
.

.
6. Contact number (
...
7. Care giver (
.

8. If client, your medical details(

)
client (

9. Languages you know(

..
10. Family income (

Farther () ..
Mother ()
Any other () ..
11. Are you dependent

( )

Independent

12. If dependent, on whom( )

..

13. Have been employed

unemployed .

14. If employed, where. Details( )

15. If unemployed, would like to be employed (,

) ..
16. What is your area of interest (what do you want to do)

( )
.

..
17. Do you need any training on this(

18. Care givers apprehensive (opinion on the job selected by the client)

( ? )

.
18. Geographical location of the person (

)..
.

20. Distance covered to the center(

) ..
.

.
21. Any opportunities around your area, for example.
( )
Industries ().
Company()..
Gardening/ nursery( / )
..

Any other, specify( )


Local networking agencies for example.
NGOs.
Government organizations.

22. If there is any of the above, details (

)
..

23.Care givers opinion on the clients social skills, self care or any other behavior. Is
there need to work on that? ( ,

?
)

24. Any other information that may be vital ( )


..

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