Training Application

Transcription

1 Exhibit Attachment Customized Training and Contracted Education Training Policies and Procedures Chapter 4. Part 1: Adult and Dislocated Worker Program Activities Training Application EMPLOYER/ CONTRACTED TRAINING PROVIDER INFORMATION Legal Business/Company Name Federal Tax ID Number Physical Address City, State, Zip Federal Tax ID Number (TIN#) Tax Status Sole Proprietor Partnership Corporation Non-Profit LLP Public Education Other: Worker s Compensation Carrier (for CT only) Policy Number Company Contact Name (First and Last) Effective Dates of Policy Contact Job Title Phone Number Extension Address Alternate Company Contact Name (First and Last) Alternate Company Contact Job Title Alternate Contact Phone Number Extension Alternate Contact Address Number of Years Business Has Been in San Diego County Are you submitting this application on behalf of more than 1 employer? Yes No If yes, please attach a list of all participating employers to this application. Type of Training Requested Customized Training (CT) Contracted Education Training (CET) Total Number of Participants to be Trained Position to Filled (CT only) Briefly describe your Business/Organization and the reason(s) for requesting training funds: Page 1 of 6

2 RECRUITMENT How do you plan to recruit eligible participants to your CT/CET program? Please check one: I want all CT/CET participants to be recruited by the America s Job Center of California (AJCC) network. I have all prospective CT/CET participants and want the AJCC network to determine their eligibility. I have a total of prospective CT/CET participants and want the AJCC network to recruit additional participants and determine their eligibility. 1. For new worker training, eligible participants are those who meet the Workforce Innovation and Opportunity Act (WIOA) eligibility requirements. The San Diego Workforce Partnership will only reimburse training costs for WIOA eligible participants. The AJCC network staff can help you determine WIOA eligibility. 2. This process may take up to 2 months. There is no guarantee that the AJCC network can recruit all participants. 3. Please provide a list of the prospective participants to be screened for WIOA eligibility with this application. Please list the qualifications required for participants in your proposed CT/CET program and include any required assessments, drug screenings, health screenings and background checks: Please describe how you will recruit participants for your program and describe any coordination with the AJCC network to determine WIOA eligibility of prospective participants: Page 2 of 6

3 Training Plan/Curriculum Name of CT/CET Program Proposed Program Start Date Proposed Program End Date Are you the employer or Organization conducting the program or using a third-party training provider? Employer/Organization Third-Party If third party, please also fill out Training Provider Information section below. Please provide a description of Services such as, how the training will be delivered, including name, titles and qualifications of instructors as well as the curriculum, class titles, dates, times and skills taught (Please attach curriculum): Third Party Training Provider Information (If Applicable) If you are planning to use a third-party training provider, please fill out the following information. If you are providing training in-house at your facilities, please leave this section blank. Legal Name of Training Provider Federal Tax ID Number Address Training Provider Contact Name (First and Last) City, State, Zip Contact Job Title Phone Number Extension Address Type of Organization Nonprofit For-Profit Public Education Other Public Liability Insurance Carrier Policy Number Effective Dates of Policy Training Outcomes Starting Hourly Wage (CT Participants Only) Are there opportunities for career advancement once completed? Yes No Will successful completers of the CT/CET attain industry certification(s) or certificate(s)? Yes No Page 3 of 6

4 Proposed Budget Please complete the following budget table, indicating each line item for the total cost of the program. Personnel/Salaries Cost Participant Cost Total Participant Supplies Cost Total Salaries Fringe Benefit Rate Total Fringe Benefits Cost Total Supplies Total Personnel Staff Training and Travel Cost Furniture and Equipment Purchase Cost Total Staff Training and Travel Total Furniture & Equipment Other Cost Facilities and Infrastructure Cost Total Facilities and Infrastructure Total Other Total Cost of Proposed Training Program Page 4 of 6

5 Proposed Budget Narrative Please complete the following budget narrative to explain how each cost will contribute to the training program. Line Item Narrative Personnel Furniture and Equipment Purchase Facilities and Infrastructure Participant Supplies Staff Training and Travel Other Total Cost for Training: How much of a reimbursement are you requesting from SDWP? For employers with 50 or fewer employees, a minimum of a 25% match For employers with 51 or more employees, a minimum of a 50% match For reimbursement amounts of $50,000 or more, SDWP must submit this application to SDWP s boards and committees for approval, which can take up to 3 months. Employer/Contracted Training Provider Match: Page 5 of 6

6 APPLICATION CHECKLIST Please attach the following if applicable: Curriculum Job Descriptions of positions to be filled with CT I understand that the San Diego Workforce Partnership (SDWP) has the right to approve or not approve this training application at its sole discretion, based on program needs, budget limitations and employer (contractor) suitability to participate in this program. I certify that all information provided in this application is true and accurate. As required by the Workforce Innovation and Opportunity Act, I understand that I will match no less than of the cost of training and intend to hire, help employ and/or retain those who successfully complete the training. I understand that SDWP may require additional information or documentation to support this application. I understand that this training application is pending final approval by SDWP. Employer or Training Provider Contact (First and Last Name) Signature Date I have read and agree with the information provided under Recruitment Plan. Upon approval of this training application, I commit to working with the employer or group of employers to successfully enroll and monitor participants in this training program for prospective new workers. Service Provider Name (First and Last) Signature Date SDWP Use Only: Programs Department Approval Signature Date Page 6 of 6