Job Seeking Skills (JSS) Referral Form

You may submit a referral using the online form below, or download a printable PDF version of the form to complete and send via fax to 919-846-4740, or mail to:

Carolina Case Management
118 Wind Chime Court
Raleigh, NC 27615

Download PDF Form Here

Job Seeking Skills (JSS) Referral Form

  • INJURED WORKER INFORMATION:

  • CLAIMS ADJUSTER:

  • CURRENT WORK RESTRICTIONS

    (if applicable)
  • CLIENT DETAILS:

  • (what other jobs can client perform? list below)
  • CASE MANAGER

  • This field is for validation purposes and should be left unchanged.