Food Service Worker Assistance Program Application
If you work in the food service industry but were laid off/terminated from your job or had your hours significantly reduced because of COVID-19, you may qualify for financial assistance. Fill out this short application and submit your most recent paycheck stub, and one of our team members will be in touch with you.

Through a grant from Oxfam, Refill is able to provide $50 to each qualified applicant. Applicants must be employed by a restaurant (local or chain), cafe, or catering company in the front of house, back of house, or delivery (if employed directly by the establishment). Persons who are independent contractors, including for food delivery providers (such as DoorDash, GrubHub, Postmates, and uberEATS), do not qualify. Applicants must be 18 years or older and must be able to pick up a paper check in person from a Jackson location.

Assistance is provided on a first come, first served basis until resources are depleted. For this initial round of assistance, each person may receive only one $50 check. If multiple people in a household work in the food service industry, each may apply and receive assistance.
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Last Name *
First Name *
Email Address *
Cell Phone Number XXX-XXX-XXXX *
Address (please include Street Number, Street Name, City, State, Zipcode).  Funds (pending application approval) will be sent to this address.  Please confirm its accuracy. *
Place of (Former) Employment *
Reason for Assistance *
Supervisor/Manager's Name *
Supervisor/Manager's Phone and/or Email Address (Preferably Both) XXX-XXX-XXXX *
Please Explain Circumstance
Proof of (Former) Employment: Proof must be a JPEG Image or PDF document of most recent paystub which must show applicant's name, employer's name, and dates of pay period.  Paystub must be emailed to assistance@refilljackson.org as an attachment.  Subject Line should read "Last Name.First Name" *
Required
Copy of State Issued Driver's License or Identification: Must be a JPEG Image or PDF document.  Identification must be emailed to assistance@refilljackson.org as an attachment.  Subject Line should read "Last Name.First Name" *
Required
By checking this box, I certify that all information is true and correct to the best of my knowledge. I understand that assistance will be provided after my (former) employment has been verified and based on remaining availability of funds. *
Required
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