Libraries Parks

Job Search Assistance


Burnsville WorkForce Center

West St. Paul WorkForce Center

Shakopee WorkForce Center

Provider Information

The following forms and guides are for contracted vendors with the County:

Department of Human Services Forms
DHS 2114 Request for Medical Opinion (Unable to Work)
DHS 2883 Request for Verification of School Attendance-Program
DHS 3165 Status Update Form
DHS 3175 Notice of Intent to Sanction
DHS 3482 MFIP Self Screen
DHS 3482A MFIP Self-Screen Scoring Form
DHS 3504 Brief Screening Tool for Special Learning Needs
DHS 4316 Assessor Treatment Provider Report
DHS 5784 MFIP Job Log Instructions
DHS 5784 MFIP-DWP Employment Services Weekly Job Search Activity Log
DHS 5837 Work Benefit Program Information
DHS 6075 Family Stabilization Services Pre-Sanction Checklist

Employment Services Forms
EDAK 0058A ESW Termination-Leave Verification
EDAK 0058ESW Employment Verification
EDAK 3017ESW Request for Training
EDAK 3393ESW MFIP Training Request
EDAK 3503ESW Family Violence Waiver Notice
EDAK 3518ESW Medical Exam Request for Disabled MFIP HH Member
EDAK 3562ESW 30 Percent Case Sanction Review
EDAK 3563ESW 30 Percent Sanction File Review Checklist
EDAK 3564ESW Sanction Letter
EDAK 3569ESW MFIP Assessment
EDAK 3588ESW 100 Percent Sanction Case Review
EDAK 3668ESW Interpreter Request from WFS Employees
EDAK 3689ESW Child Care Application Process
EDAK 3698ESW Goodwill Easter Seals MN ARMHS Program Referral Form
EDAK 3699ESW GES Referral Form
EDAK 3726ESW MFIP-DWP Family Stabilization Services Sanction Checklist

Program Forms
EDAK 0051 Training Pre-Authorization Request
EDAK 0766E Financial Authorization
EDAK 3128 Managed Care Call for Help List
EDAK 3503 MFIP Alternative Employment
EDAK 3562 30 Percent Case Sanction Review
EDAK 3563 30 Percent Sanction File Review Checklist
EDAK 3588 100 Percent Sanction Case Review
EDAK 3769 MFIP Post-Secondary Training Packet
EDAK 3772 ESL-ABE School Attendance Verification
EDAK 3773 Request for MFIP Training Denial Form
EDAK 3774 MFIP School Approval
EDAK 3775 Training Probation Form
EDAK 3781 MFIP Employability Measures Worksheet

Last updated: 11/8/2013 5:37 AM