Workability III Services Application Form

You must have an open Department of Rehabilitation (DOR) file to qualify. If you have any questions, contact Danny Navarrete at or Narda Mamou at

Please provide as much information as possible.

Asterisk (*) indicates a required field.

Personal Information
Contact Information


What is this telephone number for?:

Emergency Contact

Please provide the following information:

Income Source(s):

Please respond to the following: Are you currently an Ohlone College student?:
Are you a Vocational Rehabilitation (VR) Client?:

Do you have a driver's license?:

If yes, do you have a car?:
High School




Trade School


Workability Services

When are you available to work?:

What Workability service are you interested in?:

Work History
Current or Last Employer


Previous Employer


Policy for Services

You must read and agree to the following policies:

  • Clients agree to be the primary seekers for their own jobs. Workability III will help you find a job, but it is up to the client to follow through on responsibilities. Failure to show up on time will result in a delay of services.
  • Clients receiving services through Workability III are subject to Standards of Student Conduct and all Ohlone College regulations.
  • When looking for jobs, make sure you meet the minimum requirements for the position, and can work the days listed, and that you have transportation to the worksite.
  • Clients must notify the Workability III office if you get a job, need any assistance, or expect to leave a job or be fired for any reason.

By entering my name below and submitting this form, I certify that I understand and accept the above agreements. I give Ohlone college and/or Workability III Job Placement permission to Fax or Mail my resume to prospective employers. I understand that the staff of Ohlone College WorkAbility III have superivisory responsibility over me in the workplace and will be sharing my personal information with employers. I will abide by following the agreement as set above.

I understand by filling out this form online and submitting it that the agreement is binding.

Your privacy is important to us. Your personal information will not be sold or shared with unaffiliated third parties except as necessary to maintain and process client accounts or when the law requires it.