Ticket-to-Work Profile - Questions? Call 800.973.7687

Ticket-to-Work Profile Form

Read our privacy policy to see how we handle the personal information you give to us.

Please note that some fields are required.

NOTE: Completing this profile will take about 10-15 minutes (for most people). Many TTW holders find it helpful to have either a list of their prior work experiences or their resume available when they complete this profile. Please allow 3-4 weeks for your custom recommendations to be sent to you after completing this profile.

A paper version of this profile can be sent to you if you make the request in writing to:

The Sierra Group
TTW Profile Project
491 Allendale Rd.
Suite 320
King of Prussia, PA 19406

First Name
(Required)
Last Name
(Required)
Home Address
(Required)
City
(Required)
State
(Required)
Zip Code
(Required)
Best Telephone Number
to Reach You
(Required)
Email
(Required)
Date of birth (mm/dd/yy)
Date that you last worked
before receiving your SSDI
benefit (mm/yy)
(Required)
Describe the nature of the
disability that qualified you
for your SSDI benefit
(Required)
Do you currently have
any medical restrictions
that would prevent or
inhibit you from returning
to work? (yes/no)
(Required)
If you do have current medical
restrictions that would prevent
or inhibit you from returning to
work - please describe them
here. If this is not applicable
- please type NA in the
response field.
(Required)
How many hours a week do
you want to work? (enter a
whole number from 1 through 40)
(Required)
How much do you think that
you will earn per hour once
successful in your job search?
(enter any amount from $5.00 per
hour through $100.00 per hour)
(Required)
What is your highest level
of education?
(Required)
When did you achieve this
educational milestone?
(mm/yy)
(Required)
What was your last job title?
(Required)
Do you have a current
resume? (Yes/No)
(Required)
Have you been to a
CareerLink for job
search assistance?
(Yes/No)
(Required)
Are you actively looking
for jobs? (Yes/No)
(Required)
How many jobs have you
applied for in the past 60
days? (any whole number
from 0 through 1000)
(Required)
Are you willing to travel
to King of Prussia,
Pennsylvania for a
personal meeting to
review your vocational
options? (Yes/No)
(Required)
How many hours per week
do you have available to dedicate
to job search under our specific
training plan? (enter a whole
number from 1 through 40)
(Required)
Describe the type of job that
you are looking for - be specific
about location, hours, pay, and
challenge.
(Required)
Do you believe that you are
currently qualified and able
to maintain successful
employment in a job as
you have just described?
(Required)
Describe any assistive
technology that you use or own
Assume that the perfect job
is available to you. Please
use the space provided to
compose a cover letter for
this employer. Reference
how your skills and experiences
translate into the opportunity
that you previously described.
(Required)

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