Workforce Innovation and Opportunity Act (WIOA) - Youth Work Experience Employment and Training Program Employer Request Form On behalf of: (Agency) I wish to submit a request to participant with the Workforce Innovation and Opportunity Act (WIOA Program as an employer/training agency. If this is approved, we will adhere to the WIOA administrative requirements. The positions are as follows: x Occupational Number of Positions: Title: x Worksite Location: x Job Description: x Occupational Title Number of Positions x Worksite Location: x Job Description: x Occupational Number of Positions x Worksite Location: x Job Description: x Total number of Agency’s permanent employees: Part-time: Full-time: x Total number of WIOA participant currently receiving training with the Agency: x or Agency has has not participated with former youth Employment and Training Programs. x Number of WIOA hired/trained last year: x Agency is capable and willing to train handicapped youth. Yes No If yes, how many handicapped is the agency willing to employ under the WIOA program? List Occupation(s): x Printed Name: Printed Title: Telephone number: x Signature of Authorized Employer Date This is a Southwestern Area Workforce Development Board Form and cannot be changed/ revised without prior approval. Revised: August 2015 Equal Opportunity Employer” “An
Workforce Innovation and Opportunity Act (WIOA) - Youth Work Experience Employment and Training Program Employer Request Form On behalf of: (Agency) I wish to submit a request to participant with the Workforce Innovation and Opportunity Act (WIOA Program as an employer/training agency. If this is approved, we will adhere to the WIOA administrative requirements. The positions are as follows: x Occupational Title: Number of Positions: x Worksite Location: x Job Description: x Occupational Title Number of Positions x Worksite Location: x Job Description: x Occupational Number of Positions x Worksite Location: x Job Description: x Total number of Agency’s permanent employees: Part-time: Full-time: x Total number of WIOA participant currently receiving training with the Agency: x Agency has or has not participated with former youth Employment and Training Programs. x Number of WIOA hired/trained last year: x Agency is capable and willing to train handicapped youth. Yes No If yes, how many handicapped is the agency willing to employ under the WIOA program? List Occupation(s): x Printed Name: Printed Title: Telephone number: x Signature of Authorized Employer Date This is a Southwestern Area Workforce Development Board Form and cannot be changed/ revised without prior approval. Revised: August 2015 “An Equal Opportunity Employer”