Exhibits Chapter VI

Checklist (1) 10/1/14 Exhibit 6-A

WIA/WT

OJT Company Pre-Checklist

This pre-checklist must be completed before any On-the-Job Training is provided to the trainee

Employer Name:

Address:

Phone Number:

Contact Person:

Trainee: SSN:

Business Service Representative: Date:

Please circle a response to each item. *Items must be fully described in the comments section and on the reverse of this

form.

1. Would this employer hire and train this participant “anyway” without the use of an OJT?..........Y/N

2. Is the trainee an employee of this employer?................................................................................Y/N

3. Unemployment Compensation Insurance?.………………………………………………………………………………..Y/N

4. Worker’s Compensation Insurance? ……………………………………………………..……………………………………Y/N

5. Is this job permanent? …………………………………………………………………………………………………………………Y/N

6. Will sufficient supervision be provided? ………………………………………………………………………………….….Y/N

7. Was an employee laid off from this position within the past year? Or are current employees

being displaced or their hours reduced as a result of this OJT? ……………………………………..……………Y/N

8. Will the principal source of income for this participant be tips, commissions, or piece work?......Y/N

9. Does the Employer verify that this participant will receive the same pay

And fringes as other company employees in similar positions? ………………..………………………..……….Y/N

10. Is the participant related to a company employee in similar positions? ……………………..……………….Y/N

11. Have the contract, terms, assurances, grievance procedures and invoice procedures been

Explained and reviewed with the employer? ……………………………………………………………………………….Y/N

12. Are special accessibility requirements necessary in order that the participant be employed? …....Y/N

13. Wage $_________ Fringes_________________________________________________________

14. Are these wages and fringes comparable to other new hires with the same level of experience

in positions similar to this occupation?...........................................................................................Y/N

COMMENTS: ________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Employer Signature: __________________________________________ Date: ______________

This signature verifies that this pre-checklist has been reviewed by the employer.

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Rev. 10/1/14 Exhibit 6-B

ON-THE-JOB-TRAINING (OJT) AGREEMENT & WORK ORDER

WIA/WT

OJT CONTRACT# Funding Source: A DW Company Name: Company FEIN# City, State: Zip Code: Telephone Number: Trainee Name: SS# This contract by and between CareerSource Escarosa, Inc., hereinafter called “Escarosa”, and the Company OJT Contractor named above, hereinafter called “Employer”, is entered into for the purpose of providing on-the-job-training in accordance with the rules and regulations of either Workforce Investment Act (WIA), or Welfare Transition Program (WT). Employer agrees that they meet and understand the following guidelines necessary for On the Job Training:

a. A private sector business that has been in operation for at least one year prior to the current fiscal year. b. The positions available are newly created within the past three months. c. Job opening has been advertised on the Employ Florida Marketplace (EFM) management information system. d. Applicants have registered with EFM and have met the eligibility requirements for either the Workforce

Investment Act (WIA) or the Welfare Transition Program (WT). e. On the Job Training will not exceed $6,000.00 per trainee and will not exceed $50,000.00 per employer. f. All other policies regarding prior work experience, skill level of the occupation, skill level of the participant to

justify an OJT. Employer agrees to: Employ and train future trainees as specified on an individual work order that have been certified by CareerSource Escarosa to be eligible for services under either Workforce Investment Act (WIA), Welfare Transition Program (WT), which ever is applicable. The employer shall not place the trainee in training prior to the agreed upon training begin date and the reimbursable training shall be completed by the end date as indicated in this Work order or modification thereto in accordance with the agreement Terms. Employer further agrees to:

a. Comply with all Federal and State labor laws. b. Comply with the attached “General Terms and Assurances”. c. Submit billing for training cost stipulated in the General Terms Attachment D, Paragraph F. d. Complete periodic progress and performance reports pertaining to the participant being trained under this

agreement. e. Provide training as specified in the Training Outline to the participant for the position specified. f. To employ a trainee only after work order is signed. g. Authorize a representative to sign all OJT Documentation h. Is under no obligation to hire trainees.

CareerSource Escarosa agrees to: provide for Employer reimbursement of not more than 50% of the trainees training wage for the cost of providing the specified training and additional supervision related to the specified training period.

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Rev. 10/1/14 Exhibit 6-B

This training agreement will commence on or after the respective parties have signed this agreement and will expire on the date specified below or one year after the employer signs this agreement, whichever comes first. Position / ONET Code

Hourly Training Wage

Total Training Hours

Reimbursement Rate of 50%

Total Maximum Training Cost

Training Begin and End Dates

The employer shall pay the trainee at the agreed upon training wage on the following payroll schedule: W BW SM M Job descriptions showing minimal skill level(s) requirements for the above position(s) will be attached and made a part of this contract and will incorporate the skills to be taught to the trainee. CERTIFICATION The Employer and Escarosa do mutually agree to all the terms and conditions set forth above and incorporated by reference in attachments and certify their legal authority to enter into this contract on behalf of their respective parties. Escarosa Director Date Employer Representative Date I certify that I will act as the agent for Workforce Escarosa. Business Service Representative Date Agreement Expiration Date: _____________________________

Training Outline (1) REV. 10/1/2014 Exhibit 6-C

WIA/WT

OJT Training Outline Trainee’s Name: Objective: ONET Code: Name of Company:

This area must be completed by the Job Developer

Job Title:

Description:

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Terms (1) 3/09 Exhibits 6-D

CareerSource Escarosa

GENERAL TERMS

WIA/WT

A. Terms and conditions of employment shall apply to all CareerSource Escarosa WIAIWT OJT trainees as

afforded other regular employees, including wage increases and overtime pay. CareerSource Escarosa OJT trainees will receive wages comparable to employees who have the same level of experience for the same occupations as noted in this OJT agreement. The CareerSource Escarosa OJT trainee will be compensated at the highest of the federal minimum wage, which is currently set at $6.55, or the higher of any new state or federal minimum wages rate specified in Section (a) of the Fair Labor Standards Act of 1983 or the applicable state minimum wage law

B. The Trainee will abide by all Employer personnel, safety and health procedures and policies and will be

provided a new employee orientation covering personnel, safety and health procedures and policies.

C. The Employer agrees to provide training to the trainee in exchange for the reimbursement of up to 50% of the training wage rate for the specified training period unless otherwise modified.

D. The training time will not exceed the maximum allowed for each occupation as described in the

Dictionary of Occupational Titles (DOT) or current CareerSource Escarosa Policy.

E. Once a trainee is hired the OJT Training Outline, Work Order, and Purchase Order will be made a part of this agreement and shall be binding. The Employer agrees to train the participant in all skills listed in the training agreement by the end of the training period and to provide written justification for any omissions.

F. Records of attendance, actual hours worked, gross pay, performance, and progress shall be recorded on the

official OJT invoice/timesheet and provided to CareerSource Escarosa with a copy of the Employer's supporting payroll register each month. CareerSource Escarosa will not reimburse the Employer for overtime or paid holidays; holidays will be reimbursed only if the trainee works at the regular rate specified in the agreement.

G. The Employer will maintain and make available time and attendance, payroll and other records in support of

the amount claimed for reimbursement available to CareerSource Escarosa, USDOL or any duly authorized representative upon request, and must be retained for a period of three (3) years from the completion date of the contract or until all litigation, claims, or audits have been satisfactorily resolved, whichever is later.

H. Reimbursement will be computed in accordance with the negotiated terms, and if the intent is to terminate the

trainee, or if the trainee voluntarily terminates before the completion of the training period, the claim for reimbursement of training costs will be based on the total number of training hours the participant experiences up to the date of termination. In no event will the reimbursement be an amount in excess of 50 percent of the wages paid to the trainee for the period in question.

I. This training agreement may be terminated within 30 days, if the trainee's performance is deemed to be unsatisfactory by the Employer. If the trainee does remain in training beyond 30 days, it will be assumed that the Employer considers the trainee to be a satisfactory employee. The ultimate goal is unsubsidized employment of the trainee by the end of the official training period as described in the work order and purchase agreement. The Employer must notify CareerSource Escarosa if unsubsidized retention is not contemplated.

J. The Employer agrees to defend, indemnify, and hold CareerSource Escarosa its officers, agents, and

employees, harmless and blameless from liability of any kind whatsoever, including cost and expenses, which arise out of or are in any way connected with the performance of this agreement. The Employer shall be liable for, and shall reimburse CareerSource Escarosa for any funds paid to the Employer, which are used

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Terms (1) 3/09 Exhibits 6-D

in any manner or for any purpose contrary to the terms of this agreement, or the expenditure of which is disallowed by any governmental agency having jurisdiction to audit or regulate the use or expenditure of such funds.

K. Relatives of an Employer may not be employed through an OJT agreement.

L. CareerSource Escarosa Board members must avoid potential conflict of interest situations such as signing

OJT contracts, invoices, other OJT documents or directly influencing the selection of the trainee or any negotiation of the OJT contract terms.

M. No equipment or property may be purchased with funds received through this OJT agreement.

N. None of the work or services covered by this contract shall be sub-contracted without the prior written approval of CareerSource Escarosa and shall be specified in a written sub-contract.

O. All time sheets and invoices connected with the OJT agreement shall be submitted to CareerSource

Escarosa at the successful completion of the OJT and no later than 45 days from the ending date of the contract period. Time sheets and invoices submitted after the 45-day period will not be reimbursed.

P. This OJT training agreement shall be binding according to the contract period as noted in the effective date and ending date; whereas, CareerSource Escarosa and the Employer are desirous of submitting this agreement in written form for the services which have been provided or are being provided to CareerSource Escarosa.

Q. The parties may, by mutual written agreement, make changes within the scope of this contract, and modifications must be described in written form and agreed to prior to implementation.

R. OJT training funds provided to an employer must not be used directly or indirectly to assist, promote or deter union organizing. Written union concurrence is required where a training program would impair or be inconsistent with an existing collective bargaining agreement.

Exhibit 6-E

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CAREERSOURCE ESCAROSA, INC. ASSURANCES

A. Under the hire-first principle the Employer must hire an individual prior to his/her receiving

any training or supportive service.

B. It is the intent of this agreement to reimburse the Employer for those costs of training and the costs of lower productivity associated with employing and training an C a r e e r S o u r c e Escarosa participant herein called trainee who lacks the requisite skills to perform the job in which the individual is placed.

C. The Employer agrees that trainees shall not be employed on the construction, operation, or

maintenance of so much of any facility which is used or to be used for religious worship or instruction and will assure that no trainee will engage in any partisan or nonpartisan political activities during the training periods described in the signed purchase order and work order. The Employer certifies wages, workers' compensation, health insurance, unemployment insurance and other benefits will be provided to trainees that are the same as others performing comparable jobs and certifies that employees under this contract will be covered by Workman's Compensation or a comparable insurance policy that complies with Federal Regulations and unemployment compensation insurance, to include the Fair Labor Standards Act.

D. This Contract and the resulting hiring of trainees will not result in the displacement of employed

workers, promotional opportunities or impair existing contracts for services or result in the substitution of Federal funds for other funds in connection with work that would otherwise be performed. The trainee will not be placed into a job position, which may be effected, by layoff, a hiring freeze or other action. The Employer agrees to notify CareerSource Escarosa in writing of all proposed or planned layoffs or hiring freezes to assure compliance with this maintenance of effort regulation, which may occur before or after the agreement, has been executed. No funding provided to the Employer for OJT or customized training can be used to directly or indirectly assist, promote or deter union organizing.

E. The performance of work under this contract may be terminated by either party in whole or

part for either of the two following circumstances.

Termination for Convenience: Either party to this contract may request a termination for convenience. Either party will give a five (5) calendar day notice in writing of the effective date of such termination. The Employer will not be reimbursed for services under a contract that has not been successfully completed under this termination clause.

Termination for Cause: CareerSource Escarosa may terminate this contract when it has been determined that the Employer has failed to provide any of the services specified or to comply with any of the provisions contained in this contract. No payment will be made if this option is executed.

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Exhibit 6-E

F. Any officer, director, agent or employee of or connected in any agency receiving financial assistance under WIA/WT knowingly hires an ineligible individual(s), embezzles, willfully misapplies, steals, or obtains by fraud any of the monies, funds, assets, or property which are the subject of a grant or contract of assistance pursuant to such Act shall be fined in accordance with applicable State or Federal regulations.

G. If the funds anticipated to be received by CareerSource Escarosa, under which this

contract/purchase order is funded, are suspended or terminated in whole or in part, funding for this contract shall cease and this agreement shall terminate after the exhaustion of such funding. Unearned payments under this contract/purchase order may be suspended or terminated upon refusal to accept any additional conditions that may be imposed with immediate notice given to the Employer.

H. The Employer agrees to comply with Title VI-VII of the Civil Rights Act of 1964, Age

Discrimination Act of 1975, Section 504 of the Rehabilitation Act, Title IX of the Education Amendments of 1972 and the Florida's Human Rights Act of 1977, Title I of Public Law 101- 336 American Disability Act, and further agrees that no individual shall on the grounds of race, creed, color, handicap, national origin, sex, political affiliation, or marital status be excluded from participation in, denied the benefits of, or be otherwise subjected to discrimination under any program or the benefits of, or activity funded in whole or part with funds made available under the WIA/WT Act.

I. The Employer will maintain appropriate standards for health and safety in work and training

situation.

J. If the Employer perceives that CareerSource Escarosa has not adhered to the terms provided in the OJT Agreement, he/she may implement the following Grievance Procedures: 1. With of (30) thirty days of the incident, a formal written complaint must be filed with

the CareerSource Escarosa Assistant Director. 2. If the Assistant Director and the Contractor/Employer are not able to resolve the

Problem within ten (10) days of the receipt of the written complaint, the complaint will be taken to the CareerSource Escarosa Executive Director

3 If the Director and the Contractor/Employer are not able to satisfactorily resolve the problem, the complaint will be taken to the appropriate CareerSource Escarosa standing committee where a final decision will be made.

K. If you the Employer perceive that CareerSource Escarosa or agent has violated your rights

due to an act of discrimination based on race, color, sex, national origin, religion, disability, age, political affiliation or belief, you are encouraged to file a complaint of discrimination with CareerSource Escarosa for review and resolution. This process is described in the attached Grievance Hearing procedures. If the Employer has no grievance procedures in place for its employees, the trainee may use the attached Grievance Hearing Procedures.

L. Verification may be accomplished by on-site reviews of project operations; inspection and/or

transcription of any and all project reports, documents, records; interviews with any beneficiary; or observation of any actions covered under the contract.

Exhibit 6-E

M. If the employer determines that the WIA/WT trainee is not capable of learning and/or performing the duties listed in the training outline, the Contractor/Employer must give the participant five (5) days notice prior to termination. Terminations for other reason (i.e. insubordination, excess absences, rude/obscene behavior, etc.) must be documented and provided to CareerSource Escarosa at the time of termination of the employee. Terminations for these reasons do not require five (5) days notice. The Employer may be reimbursed for the time training was provided if the above termination are justified and approved by the CareerSource Escarosa Assistant Director. If the trainee does remain in training for more than 30 days, it will be assumed that the Employer considers the trainee to be a satisfactory employee.

Exhibit 6-F

Grievance/Complaint Hearing/Appeal Procedures

Workforce Investment Act (WIA), Trade Adjustment Act (TAA), Welfare Transition (WT/TANF) and Wagner-Peyser (WP) program participants and other interested parties (e.g., contractors, One-Stop partners, One-Stop operators, and employers) affected by decision or actions of the local workforce system have a right to file grievances/complaints with the local Regional Workforce Board. The grievance/complaint should be filed with CareerSource Escarosa, Inc., in accordance with the procedures listed below. In the event you submit a grievance/complaint not under the authority of CareerSource Escarosa, Inc., CareerSource Escarosa will notify you within five (5) working days from the receipt of the grievance/complaint of the relevant agency responsible for the grievance/complaint.

'Escarosa will notify you within 5 working days from the receipt of the grievance/complaint of the relevant a

Sexual Harassment Policy

CareerSource Escarosa Sexual Harassment Policy will be provided for you.

Criminal Fraud and Abuse

The procedures for reporting such incidents and instructions for completing the incident reporting form can be found at the following web site: http://www2.myflorida.com/awilpdg/incidentreport/default.htm The form should be completed and mailed to: USDOL Office of Inspector General, Office of Investigations, Room S5514, 200 Constitution Avenue NW, Washington, D.C. 20210 or to USDOL South East Regional Inspector General for Investigations, Office of Investigations, Sam Nunn Atlanta Federal Center, 61 Forsyth Street, SW, Suite 6T1, Atlanta, Georgia 30303. Reports or complaints alleging fraud and abuse may also be reported through the USDOL Hotline at 1-800-347-3756. Reporting Discrimination Complaints

To receive forms and procedures for filing discrimination complaints call AWI at (850) 488-722, ext. 1330, 1340, 1338 or visit the following website: http://www2.myflorida.com//awi/pdglcivilrights/forms.pdf. You may file a discrimination complaint directly with the CareerSource Escarosa EO Officer, Ms. Janay Sims 3670 North L Street, Pensacola, FL 32505, (850) 607-8700. A WIA/TAA complaint file with the U.S. Department of Labor, Civil Rights Center Discrimination Complaints 200 Constitution Ave., NW, Room N-4123 Washington, D.C. 20210 and a copy mailed to AWI, Office for Civil Rights, Suite 150, Caldwell Building, East Madison Street, Tallahassee, FL 32399-4129; and with the EEOC Tampa Area Office 501 East Polk Street, lOth floor Tampa, FL 33602 (813) 228-2310 or TTY (813) 228-2003. A WT complaint file with U.S. Department of Health and Human Services, Office of Civil Rights, Inspector General Sam Nunn, Atlanta Federal Center, 61 Forsyth Street, SW, Suite 3B70, Atlanta, GA 30303 and a copy mailed to AWI, Office for Civil Rights, Suite 150, Caldwell Building, 107 East Madison Street, Tallahassee, FL 32399-4129; and with the EEOC Tampa Area Office 501 East Polk Street, lOth floor Tampa, FL 33602 (813) 228-2310 or TIY (813) 228-2003. You may file electronically at the following address civil.rights@awi.state.fl.us. A WP

complaint may be filed directly with a local-office EO Officer or with the U.S. Department of Labor, Civil Rights Center Discrimination Complaints 200 Constitution Ave., NM, Room N-4123Washington, D.C. 20210. If the person filing the complaint is sight or speech impaired, they should call the Florida Relay System at 1-800-955-8771 (TDD) or 1-800-955-8770 for voice assistance.

Filing a Grievance/Complaint and request for Hearing/Appeal with Workforce Escarosa, Inc.

A WIA/TAA/WTP individual or entity, adversely affected by a CareerSource Escarosa action, to include but not limited to: displacement of employee; denial or termination as a WIA training provider; denial of eligibility as a WIA OJT or customized training provider; participant sanctioned for using controlled substances; termination of program eligibility or sanctioning for non-compliance with work activities, may submit a Grievance/Complaint or hearing request. Submissions should be concise and clearly written or typed; state the facts, laws, procedures, etc. that the grievant/complainant believes to be relevant for review; and must include a legible address where official notices may be mailed to the grievant/complainant; include the words REQUEST FOR A HEARING at the top of the first page in capital letters; and specifically state the type of violation and nature of the action that is the subject of the grievance. The grievance shall be no longer than five pages (exhibits and attachments are not included in the five-page limit) and submitted to CareerSource Escarosa, Excutive Director, 3670 North L Street, Pensacola, FL 32505. If possible, CareerSource Escarosa will attempt to resolve the grievance/complaint informally. If the matter cannot be resolved informally, CareerSource Escarosa must establish a hearing date, complete the hearing and issue a decision within a 60=calendar day timeframe from the date the grievance/complaint was filed. When the matter is not resolved informally, you will be notified by certified mail return receipt at least 15 calendar days prior to the hearing. The written hearing notice will include: hearing procedures, date, time, and place of the hearing; pertinent sections of the WIA, WT, and any federal regulations involved. Affected parties may be represented at the hearing by an attorney or other representative, and may present witnesses or documentary evidence at the hearing. The parties will receive a written decision of the hearing within 30 calendar days after the hearing by certified mail return receipt requested.

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Exhibit 6-F

Individuals alleging a labor standards violation may submit the grievance/complaint to binding arbitration procedure if the affected parties are covered by a collective bargaining agreement. WP participants may file discrimination complaints against the Agency for Workforce Innovation (AWI) or its employees or complaints alleging discrimination by an employer. Special handling procedures are required for complaints filed by Migrant and Seasonal Farm Workers (MSFW). The RWB shall attempt to resolve the MSFW complaint. If the MSFW complaints cannot be resolved within five working days of receipt of complaint by the RWB, the complaint form and copies of all documents in the complaint file are forwarded to the Agency for Workforce Innovation, Monitor Advocate Office, Caldwell Building-Suite 150, 107 East Madison St, Tallahassee, FL 32399-4133. Attention: Senior Monitor Advocate. *Note: Individuals with a disability needing special accommodations shall call CareerSource Escarosa at (850) 607-8700 or fax at (850) 607-8852 at least five (5) working days prior to the hearing and state what special accommodation requirements are needed in order to participate in the hearing.

Right to Appeal:

An individual, or entity, adversely affected by CareerSource Escarosa actions or decisions can file an appeal with the State WIA/TAA Administrative entity. An appeal may be made to the federal level (USDOL) if the state has not conducted a hearing a decision regarding the grievance/complaint within the mandated 60-calendar day timeframe, or if either party is dissatisfied with the state hearing decision. If the AWI Administrative Entity in conjunction with State Board staff determines that a grievance/complaint filed at the State level should have been decided at the local level, then the grievance/complaint may be remanded back to CareerSource Escarosa. Filing a Grievance/Complaint and request for Hearing/Appeal at the State Level:

Because of the many types of grievances/complaints and level of hearing/appeals allowed under WIA/TAA/WT regulations, AWI staff working in conjunction with the State Board staff will be responsible for reviewing and determining the appropriate processing of requests/appeals filed at the State level. The following procedures should be followed when filing a grievance/complaint and/or requesting a hearing/appeal regarding a CareerSource Escarosa decision. The request and/or grievance/complaint for a hearing appeal should be clearly identified at top of the first page, i.e., REQUEST FOR HEARING. The written hearing request should not exceed five pages (not including attachments) and should state the facts, procedures, etc. that the grievar1tlcomplainant believes to be relevant for review and, if applicable, shall include any written decision made by CareerSource Escarosa and an address where official notices may be mailed to the grievant/complainant. The request shall be sent by certified mail return receipt to AWI, Office of General Counsel, Caldwell Building-Suite 150, 107 East Madison Street, Tallahassee, FL, 32399-4128. The grievant/complainant and CareerSource Escarosa will be contacted at least 5 working days of receipt of the complaint to attempt an informal resolution. If informal methods do not resolve the issue, then a hearing will be scheduled. The complainant/grievant will be notified of the specific procedures for the hearing and will receive a decision within 60 calendar days from receipt. State and Federal Appeal Level Process:

If the DEO has not reached a decision on the appeal of a local decision or the grievant disagrees with the decision, the grievance/complainant can file an appeal to USDOL no later than 60 calendar days of receipt of the decision being appealed. That request is submitted by certified mail, return receipt to Secretary USDOL, Attention: ASET, Washington, D.C. 20210. A copy of the appeal must be simultaneously provided to AWI (address above). Actions that may not be appealed to USDOL include: sanctions applied at the local level for using a controlled substance; sanction for non-compliance with work activities; or denial of eligibility as a WIA/TAA training provider. WP states that non-ES related complaints (employment, discrimination, health and safety, etc.) must be forwarded as soon as possible after being received, to AWI, Office of General Counsel, Caldwell Building- Suite 150, 107 East Madison St, Tallahassee, FL, 32399-4128, or to the appropriate federal agency with a copy of the complaint sent to AWI Office of General Counsel. If the WP complaint is not resolved within 15 working days, then the complaint and associated file documents are forwarded to the AWI, Office of One-Stop and Program Support, Caldwell Building-Suite 105,107 East Madison St, Tallahassee FL 32399-4133, Attention: ES Complaint Coordinator.

I certify that I have read and understand my rights and responsibilities as enumerated above.

Participant/Service Provider/ Employee/Employer or Other Signature & Date

As a representative of CareerSource Escarosa, I verify that the above-signed individual has read the Grievance

Hearing/Appeal Procedures and has indicated an understanding of it. CareerSource Escarosa Representative Signature & Date

Page 2 – Grievance/Complaint Hearing/Appeal Procedures

Training Agreement (1) 03/09 Exhibit 6-G

OJ Employee Training Agreement

The OJT Employee must read and initial. Copies of this form to be provided to OJT Employee and the original inserted in the client record. OJT Trainee Agreement

Read each of the following statements and initial in the space provided to indicate you understanding and agreement.

1. ________ I understand that the goal of OJT is permanent employment.

2. ________ I understand that if I have any concerns while on the job I should talk to my Work Supervisor.

3. ________ I agree to discuss with my Business Service Representative any concerns encountered while on the job.

4. ________ Once I have completed my OJT activities, I will maintain contact with my Business Service Representative regarding my progress in support of WIA follow-up requirements.

5. ________ I will notify my Business Service Representative if my address or telephone number changes.

6. ________ I have read and understand that my employer will provide me training and employment within the job description of the Training Outline and other job duties as my employer and supervisor requires.

Insert a signed copy into customer’s file

Trainee Signature Date

Business Services Representative Date