Please note, if you are seeking career counseling or mental health services, please use the Contact Form located on our Contact Us page.



Please complete this required form if you are referring a Maryland WCC case.

MalcolmDubato Provider #165

Contact us for staff practitioner numbers, or refer to the WCC’s Listing of Registered Vocational Rehabilitation Counselors.

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Referral Form - Workers' Compensation Cases

  • Employer/Insurer Information

  • Claimant Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Claimant Attorney Information

  • Defense Attorney Information

Referral Form - Personal Injury/General Liability Cases

  • Case Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Referral Source Information

  • Billing Information

Forms & Resources For Vocational Clients

Sample Employment Application

Please complete this sample employment application and submit it to your vocational consultant for review.

Sample Application

Independent Job Search Form

Please submit your IJS form to your vocational consultant before the close of business [5:00 p.m.] on your assigned due date. You may complete the form below or the paper copies provided to you.

IJS Form

Post-Interview Assessment

Please complete and submit this form to your vocational consultant after each interview.

Post-Interview Assessment


Job Search Websites:


Computer Skill Enhancement Websites: 

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