Vocational Assistance Certification Program Individual Certification Under OAR 436-120 {1880}

1880 - VOCATIONAL ASSISTANCE CERTIFICATION PROGRAM INDIVIDUAL CERTIFICATION UNDER OAR 436-120. This form is used to apply for initial certification or renewal of certification under the Workers’ Compensation Division’s Vocational Assistance Certification Program, as outlined in OAR 436-120. Individuals applying for certification must be employed by a registered vocational assistance provider, insurer, or self-insured employer. The form allows applicants to request certification as a vocational rehabilitation counselor, vocational rehabilitation intern, or return-to-work specialist. It requires the applicant to provide personal and contact information, employer details, and documentation supporting their qualifications, such as professional certifications, continuing education units, education transcripts, or work experience. The form also includes a section for describing specific job duties and work history. Applicants must sign to confirm the accuracy of their submission and are advised that providing false or misleading information may result in rejection or revocation of certification. The completed form and all required supporting documents must be submitted to the Workers’ Compensation Division’s Employment Services Team for review. www.FormsWorkflow.com