BACKGROUND: Customized employment (CE) is a highly relevant but underused strategy for individuals with significant disabilities. It is important to examine how CE has been utilized in state vocational rehabilitation agencies (SVRAs). OBJECTIVE: The purpose of this study is to identify SVRAs’ CE service patterns and outcomes from 2017 to 2020. METHODS: Descriptive analysis, chi-square, and t-test comprised data analysis. RESULTS: 78% of the consumers receiving CE were associated with 10 SVRAs. This sample (N = 1,779) was 57.4% male and 42.6% female and had a mean age of 31.61 years. 77% were White. The frequent services provided with CE were VR counseling and guidance, assessment, and job placement assistance. Based on the service provision pattern, the agencies were separated into Group A, using co-occurring services other than supported employment (SE), and Group B, using SE along with CE. Consumers served by Group B are more likely to have cognitive impairment, intellectual disability, and the most significant disability. Group A is associated with lower employment, higher weekly earning and weekly hours worked. CONCLUSION: VR agencies and providers should consider these findings to refine and improve their service delivery and policies/procedures particularly for customized employment.