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NEW REFERRAL FORM PROCESS:

PLEASE EMAIL THE FOLLOWING INFORMATION

WITH YOUR REFERRAL:

Email the referral information to one of the following WEDL staff members:

Bobette Berno: [email protected]

Kristi Gamer: [email protected]

RoxAnne Simonson: [email protected]

Tammy Langbehn: [email protected]

Katherine Zapata: [email protected]

Colleen Wilkowske: [email protected]

John Wedl: [email protected]

Don’t see the name you are looking for?: [email protected]

REFERRAL INFORMATION:

Simply “Cut and Paste” this information into a secure email and send to one of the email address above.

Disability Claims Referral   (Work Comp Referral Form Below)

Case Manager Name:

Case Manager Email Address:

Case Manager Phone Number:

Case Manager Address:

Claimant Name:

Claimant Email Address:

Claimant Phone Number:

Claimant Address:

Claimant Year of Birth:

Claimant Claim #:

Claimant Employer Name:

Claimant Physical or Other Restrictions:

Rehab Plan Details (Job Search Direction/Interests, Job or Industry Titles):

JOB PLACEMENT SERVICES REQUESTED: (Disability Claims)

___ Proactive Job Placement Services Base Package (Includes Initial Meeting, Resume Writing, Value Proposition Statement, Networking and Cold Calling Training and Exercises, Behavioral Interviewing Training and Practice, Video Interviewing Exercise, Final Meeting.  

___ Additional 4 Weeks Job Development 

___ Additional 8 Weeks Job Development

___ LinkedIn Training (2 Sessions)

___ Direct Resume Mailer to Employers

___ Skills Assessments and Computer Tutorials

___ Virtual Computer Training

___ Labor Market Survey

 

Workers Compensation Referral

QRC Name:

QRC Email Address:

QRC Phone Number:

QRC Address:

Injured Workers Name:

Injured Workers Email Address:

Injured Workers Phone Number:

Injured Workers Address:

Injured Workers Year of Birth:

Injured Workers Claim #:

Injured Workers Employer Name:

Injured Workers Physical or Other Restrictions:

THANK YOU FOR YOUR REFERRAL!  WE WILL BE IN TOUCH WITH YOU WITHIN ONE BUSINESS DAY.

OUR CONTACT INFO

We look forward to hearing from you!

Address:  5909 Baker Road
Suite 570
Minnetonka MN 55345

Main Line:
Phone: 952-929-9107
Fax: 952-487-4342