Standard Vendor Application - CRP

New Jersey Vocational Rehabilitation Services

Standard Vendor Application

 

Please complete this application if you wish to provide vendor services for the New Jersey Department of Labor and Workforce Development, Division of Vocational Rehabilitation Services (DVRS).

To obtain your UEI (Unique Entity Identifier) number, visit sam.gov. To obtain your NJStart number, visit njstart.gov.

Note: any question with an " * " is required to be completed.

Vendor ID and Contact Information

Business Location and Mailing Address

Is the business address the same as the mailing address?

Vendor Business Information

Type of business or service for which you are applying (select all that apply)
Counties to be served (select all that apply)
Is this business classified as private?
Is the business classified as a non-profit?
Supported Employment
Are you already a vendor for Supported Employment with NJDOL DVRS?

You must be a Supported Employment Vendor with NJDOL DRVS before applying to become a vendor for CBWE, Customized Employment, Internship, or TWE. Applying to these services without being an existing Supported Employment vendor will result in your application being denied.

Supported Employment Expanding Counties

Indicate the counties in which you CURRENTLY serve.
Indicate the counties in which you want to expand into.
Are you a current Supported Employment/Long-Term Follow-Along provider for DDD?
Provide statistics for the last 3 years.
Do you have a minimum of two full time job coaches?
Trainings Attended
If you do not currently have such accreditation, you will be required to obtain the accreditation within 3 years of your application to become a DVRS vendor.

Exisiting Vendor Additional Questions

New Supported Employment Vendor Questions

Does your organization complete financial audits by an independent auditor annually?

As a non-profit you must complete financial audits in order to be considered. By selecting "No" your application will be denied.

Does your organization have liability insurance/coverage?

If you do not have Liability Insurance your application will be denied.

Has your organization been providing the service you are applying for for at least 2 years or are you able to demonstrate the capacity to provide this service?
Do you have additional funding sources besides DVRS to support salaries?
Does your organization belong to any of the following? (Select all that apply)
Do you provide services to the NJ Division of Developmental Disabilities (DDD)?
Please indicate the counties in which you provide services to the NJ DDD:
Do you have a valid location/address that meets ADA standards?
Counties to be served for Supported Employment (select all that apply)

Supported Employment and Classified as a Non Profit

Do you have a governing board?
Has there been a board meeting in the last 6 months?

CBWE Questions

Does your organization have liability insurance/coverage?

If you do not have Liability Insurance your application will be denied.

Counties to be served for CBWE (select all that apply)

Customized Employment Services Questions

Does your organization have liability insurance/coverage?

If you do not have Liability Insurance your application will be denied.

Counties to be served for Customized Employment (select all that apply)

Internship Development & Supports Questions

Does your organization have liability insurance/coverage?

If you do not have Liability Insurance your application will be denied.

Counties to be served for Internship Development & Supports (select all that apply)

Trial Work Experience Questions

Does your organization have liability insurance/coverage?

If you do not have Liability Insurance your application will be denied.

Counties to be served for Trial Work Experience (select all that apply)

E-Signature

By signing below, I am electronically signing this application and verifying that the information submitted is correct. This electronic signature has the same legal effect as a written signature.