Dr222 2026

1. Click ‘Get Form’ to open the dr222 in the editor.
2. Begin by filling in your personal information, including your Last Name, First Name, Middle Initial, and any Other Name(s) Used. Ensure accuracy as this information is crucial for identification.
3. Provide your Street Address and Mailing Address if different. Include City, Zip Code, Phone Number, County, Social Security Number, Date of Birth, Cell Phone Number, and Age.
4. In the section regarding your physical or mental impairment, describe how it constitutes a substantial impediment to employment. This helps the Department understand your needs better.
5. Indicate how you can be assisted by selecting options related to job placement and providing details about who referred you.
6. Complete the Release of Information section by choosing YES or NO regarding consent for information sharing with prospective employers.
7. Sign and date the form at the bottom. If applicable, ensure a Parent/Guardian's signature is included for minors.

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