Access to Work Application Form 2021 - Application and Eligibility Details

Sep 19, 2026

Access to Work is a program designed to improve reliability and transportation for Access customers traveling to and from work or job training sites. The letter explains eligibility based on low income guidelines, limited funding, and how Access will review applications, confirm qualification, and adjust pickup times when applicable. The document includes a complete application form collecting Access ID, contact and pickup addresses, employment information, annual family income by household size, and a signature and mailing instructions to Access Services.

LanguageEnglish

CategoryForms

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

Access to Work Program Notice

Benefits and Eligibility Criteria

Application Form

Annual Family Income Table

Signature and Mailing Instructions

The Access to Work Program Access Services is excited to announce a program called “Access to Work.”This program has been developed to improve reliability and transportation services for Access customers who use Access to go to and from work or job training sites. You have been identified as a potential candidate for this program because you currently use Access trips to get to and from your work. If you are interested in participating and meet the low income guidelines, please complete the enclosed application and mail it back to Access. Access will determine your eligibility and inform you whether you will be able to use this service for your work-related trips. Some of the benefits the Access to Work program are: 1. A Standing Order Service for customers going to work or job-training 2. Scheduling to arrival times at places of employment: Trips are scheduled so that customers will arrive at their work site on time 3. One way fare of $2.00 4. Service is available to conform with a variety of work schedules The program has a limited budget and is only available to Access customers who meet the low income guidelines. Furthermore, there is no assurance that the program will continue after funding for it has ended. Once we receive your completed application, Access will determine your eligibility, contact you with the results, and determine whether if qualified, you wish to go forward as a participant in the program. Pick-up times you have had in the past may change if you are part of this program. If you do not want the time change, you can decline the invitation. If you have a current Standing Order reservation, your trips will remain as they are now. If you have questions or comments regarding the program, please call Access Services’ Customer Service at (800) 827-0829. Sincerely, Access Services ACCESS TO WORK APPLICATION FORM Access ID: Full Name: Home Address: Pickup Address (if different from Home Address): __________________________________________________________________ 1. EMPLOYMENT INFORMATION (PLEASE PRINT CLEARLY) Employer Name: Work Phone: Work Address: Work City: Work Zip: Hours Worked per Week: Work Start / End Times: Mon: / Tue: / Wed: / Thu: / Fri: / Sat: / Sun: / 2. ANNUAL FAMILY INCOME Initially, this new program will be open only to Access customers whose annual income level is at or below the amount listed for the size of your family household: | Size of Household | Annual
Income | | Size of Household | Annual
Income | | Size of Household | Annual
Income | | --- | --- | --- | --- | --- | --- | --- | --- | | 1 | $19,320 | | 4 | $39,750 | | 7 | $60,180 | | 2 | $26,130 | | 5 | $46,560 | | 8 | $66,990 | | 3 | $32,940 | | 6 | $53,370 | | | | a. How many persons, including yourself, live in your household? b. What is your annual income? 3. SIGNATURE (PLEASE SIGN AND DATE) I, , certify that the information that I have provided is true to the best of my knowledge. Signature: Date: Please mail your completed application to Access Services to: Access Services Attn: Access to Work PO Box 5728 El Monte, CA 91734 For questions or comments about the Access to Work program, please call Access Services Customer Service at (800) 827-0829.

FAQs

Who is eligible for the Access to Work program?

Access customers who use Access trips to get to and from work or job training sites and who meet the low income guidelines are potential candidates. Access determines eligibility after receiving a completed application.

What benefits does the Access to Work program provide?

Benefits include a Standing Order Service, scheduling to arrival times so customers arrive on time, a one-way fare of $2.00, and service availability to support different work schedules.

What happens to pickup times after applying?

Pickup times you had in the past may change if you are part of this program. If you do not want the time change, you can decline the invitation, while existing Standing Order reservations remain as they are.

Sep 19, 2026

Upload by Emma Mercer