CalWORKs Employment Services

County Forms (in English & en Espanol)

• WEL 3255 Monthly Activity Report (PDF, 1.16 MB)
• WEL 3255Sp Reporte De Actividad Mensual (PDF, 1.18 MB)
• WEL 3354 CalWORKs Thrive By Five Opt In Notice (PDF, 156 KB)
• WEL 3354Sp CalWORKs Thrive By Five Notificacion Informative y Formulario de Opcion (PDF, 156 KB)
• WEL 3360 Consent to Release Referral Information (PDF, 193 KB)
• WEL 3360Sp Autorización para compartir información de referencia (PDF, 193 KB)
• WEL 3268 Request for Supportive Services (PDF, 236 KB)
• WEL 3268Sp Solicitud del Participante Para Servicios De Apoyo (PDF, 258 KB)
• WEL 3287 Mileage Claim Form (PDF, 1.21 MB)
• WEL 3287Sp Formulario De Reclamo De Millaje (PDF, 2.00 MB)
• WEL 3257 Job Search Record (PDF, 155 KB)
• WEL 3257Sp Registro De Busqueda De Empleo (PDF, 186 KB)

State and Federal Forms

All forms are also available at the Customer Service Centers.  The links below will take you to the State of California Dept. of Social Services website.

• CW 61 Authorization to Release Medical Information (PDF, 55 KB)
• CW 61A Physical Capacities (PDF, 156 KB)
• CW 61B Mental Capacities (PDF, 22 KB)
• CW 2186A CalWORKs Exemption Request Form: https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2020/A-D/CW2186A.pdf?ver=2021-04-27-100007-910

Spanish Translations

• CW 61 Authorization to Release Medical Information (PDF, 45 KB)
• CW 61A Physical Capacities (PDF, 164 KB)
• CW 61B Mental Capacities (PDF, 11 KB)
• CW 2186A Peticion Para Una Exencion En CalWORKs: https://www.cdss.ca.gov/cdssweb/entres/forms/spanish/cw2186asp.pdf