Skip to content
Disclosure Form
Disclosure Form
Notify
I understand that CareerSource Palm Beach County may need to confirm information about me with other agencies or my employer, such as my job start date, end date, title, or wages. This information will be used to confirm my eligibility for programs, track the results of the services I receive, and demonstrate the positive outcomes of these programs. By allowing CareerSource Palm Beach County to collect this information, accurate federal and state reporting can be maintained to help ensure these programs and services remain available for others in the future.
By signing below, I authorize CareerSource Palm Beach County to collect information about my employment from my employer and other agencies as described above.
First Name
M.I.
Last Name
Your Email Address
Signature
Sign Here
Date
Submit
An equal opportunity/employer program. Auxiliary aids and services are available upon request to individuals with disabilities.
