We prefer that our referrals come from organizations with whom we've partnered or from organizations who would like to partner with us. All of our partners are required to provide a point of contact to us for each individual referral, and if they are hired, this point of contact must stay in touch regularly throughout their term of employment. Active case managers are also preferred here, but they are not a requirement for the application.
Boston Healthcare for the Homeless Program
Bridge Over Troubled Waters
Boston Public Schools
Cambridge Coordinated Access Network (C-CAN)
Cambridge Multi-Services Center
Cambridge Health Alliance
City of Cambridge Department of Human Services
Friends of Boston's Homeless
JRI (Youth Harbors)
More Than Words
Pine Street Inn's iCater Program
Pine Street Inn (General Shelter Referral)
St. Francis House
Suffolk County Department of Corrections
Y2Y Harvard Square
Youth Action Board (YAB)
Youth on Fire
Other (please describe below)
If your organization is not listed in the dropdown, please describe your group here. Individuals looking for employment must first go through one of our partner organizations (listed above), but we are always looking for new partners.
Name of this Organization's Referral Representative
* Name of this Organization's Referral Representative
Who is submitting this application?
Email Address of Referral Representative
Name of Person You're Referring
* Name of Person You're Referring
We are only operating out of one location at this time.
Would Your Referral Have Reliable Transportation to Work? If Not, Is This Something You'd Be Able to Provide?
Our primary goal and mission is to provide all of our employees with the best experience possible and with the proper flexibility to make that possible. Transportation can be an obstacle for many people, so this is a barrier that we want to collectively take down for every employee. Please let us know how best we could collaborate to attain a T pass for employees.
Breaktime will not discriminate on the basis of age. However, our programming is catered towards transitional-age young adults. Ultimately, this could mean people as young as 18 or as old as 24, but--again--this is NOT a requirement.
When Could They Start?
As Much Contact Information as You Can Provide
Primarily, we need their phone number and email address.
Is This Individual Experiencing Homelessness?
According to the National Health Care for the Homeless Council, "A homeless individual is defined in section 330(h)(5)(A) as ‘an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing.’ A homeless person is an individual without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation.” This information was directly sourced from Section 330 of the Public Health Service Act (42 U.S.C., 254b).
As you know, the focus of our employment efforts revolves around the population of people experiencing homelessness. Thus, truthful responses to this question can only HELP an applicant.
How Do You Know This Individual?
Description of Your Organization's Case Work with This Individual
We recognize that many employees will need mental health support, housing support, addiction support, help acquiring their GED, etc. Thus, we ask that referral organizations provide at least a point of contact but also--preferably--an active case manager who can help ensure that they have access to all the resources they need to succeed and thrive.
Description of Their Employment Experience
Why Are They a Good Fit for Our Company?
We hope to retain employees for around a year. We're interested in taking people with a wide array of career goals (not just retail). We look for responsible, confident, sociable initiative-takers who are ready and excited for job opportunities like ours.
What Information Would Be Helpful To Know for Pairing Them with a Career Advisor?
We pair each of our employees with a one-on-one career advisor who can help them with everything from creating a resume to searching for a job to connecting them with helpful contacts in their network. Please describe the career interests, background information, and other things about this person that could help in this "match-making" process.
Case Manager Contact Information/Any Other Point of Contact
As mentioned previously, we require that any referral be paired with a point of contact from the referral organization, with whom we can discuss what resources the employee would need and what programming they'd benefit from throughout their time with us. We strongly prefer that our employees also have some sort of case worker paired with them throughout their entire time with us. With that in mind, please explain the relationship that your organization would be able to maintain with this referral throughout the application process and throughout all of their time employed with us (if they are selected).
Anything Else We Need To Know?
Authorization for Release of Information Form
* Authorization for Release of Information Form
This form certifies your agreement to release information to the management team of Breaktime about the individual you're referring. If your referral is employed, this line of communication between our two organizations is considered applicable for the duration of their one-year tenure in our vocational training and career advising program (VTCAP). After that time, they may continue to work at Breaktime at a higher level, but your organization would no longer be responsible for this communication.
Any information received by Breaktime, LLC (hereafter “Breaktime”) pursuant to this authorization is intended exclusively for the use of Breaktime and is not to be re-released to any person/agency not affiliated with Breaktime without my consent, except as provided by law. Some of this information will be used to create a case file that an employee’s Career Coach and direct employers can access to track progress on an employee’s goals, pursuant to their Performance Plan.
By tying your name below, you agree to the following:
I hereby release Breaktime and its officers, agents, employees, representatives, successors, and assigns, from any claims or liabilities arising out of release of information pursuant to this authorization.
I understand that funding agencies review client files to ensure that funds are utilized in accordance with contracts. In the event that my file is selected for review, I grant access to the reviewers.
I may withdraw this authorization by giving you written notification at any time. In the absence of my prior withdrawal, this authorization will expire one year after it is signed.
I understand that a point of contact (preferably a case manager) must stay in touch with Breaktime about their specific referrals. I accept that this will continue throughout their term of employment if employed.
I have read, understand, and agree to the above release of information.
To affirm your signature, please write today's date here. This will certify your acceptance of the Authorization for Release of Information Form.
Thank you so much for your referral submission! We will follow-up with you soon about the applicant you referred. A direct call with you to discuss this applicant will be required. If we have a potential opportunity for them after that call, we’ll need a the applicant to tell us there story and explain why they are (1) interested and (2) ready for this position. This can be in the form of a resume and cover letter or something else if the applicant prefers. We’ll then schedule an interview with them in or around the cafe they’d be working at. We plan on guaranteeing all applicants an interview as long as they submit the right materials to us and are able to secure their birth certificate and government ID.
Please contact email@example.com with any questions or concerns!