Fillable Customer’s Attending, Enrolled Or Accepted Into Education/Training Informational Packet (Allen County Ohio)

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Customer’s Attending, Enrolled Or Accepted Into Education/Training Informational Packet (Allen County Ohio)

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Customer’s Attending, Enrolled or Accepted into Education/Training
Informational Appointment Checklist
PLEASE READ INFORMATION BELOW:
THIS PACKET MUST BE COMPLETED before you can meet with a Case Manager. Once you have everything on the
checklist completed, please call (419) 999-0360 and ask to schedule an informational appointment. Please reserve program
questions for the Case Manager who will review the checklist with you.
Please ensure you have following items with you when you make appointment with Case Manager.
If not applicable to your situation, please indicate N/A
Documentation needed for you to bring to your scheduled appointment with Case Manager:
Age – Birth certificate, Baptismal Record, DD214, Driver License, OR Passport
Citizenship – Social Security Card, Birth Certificate, Baptismal Record, OR Passport
Social Security Number – Social Security Card, DD214, OR Passport
Selective Service – If male, born after Jan.1, 1960. DD214 or verification of registration (www.sss.gov
)
Dislocated Worker – Layoff letter or Unemployment Compensation Verification
Income – All income for all household members for the last 30 days
Resume – Updated resume
OMJ Employment Contact Form or documentation of your job search for the last 30 days (if unemployed)
OMJ Individual Assessment/Application completed
OMJ Job History Form completed
Labor Market Information - Minimum of 5 current job postings related to your request for training or LMI from
www.ohiomeansjobs.com
. Other permissible sources include: newspaper clippings, job postings from
legitimate job board websites, or a letter of intent to hire from employer.
Customers Attending School:
Need & Resources Form
Session/Semester Breakdown Form
Transcript
Bill / Invoice from School
Customers Enrolled or Accepted in Training
Acceptance letter or clinical acceptance
letter Need & Resources Form
Session/Semester Breakdown Form
FAFSA ( FAFSA Print Out or Award Letter FAFSA
MUST be completed prior to seeking WIOA Assistance
ALL MEDICAL STUDENTS must verify their background. Verification of this can be found at www.limamunicipalcourt.org or
your local municipal court if not an Allen County resident.
PLEASE NOTE: The Workforce Innovation and Opportunity Act (WIOA) is not an entitlement program and you are not guaranteed career
or training services. Your eligibility and suitability for services will be determined by a WIOA Case Manager.
WIOA 900-12/Revised 11/2017
Individual Assessment /Application
READ & COMPLETE CAREFULLY
You will be rescheduled if this form is not completed in its entirety
What type of service are you exploring? Job Search Education/Training On-the-Job Training
Name:
Date:
Mailing Address: City: State: ZIP:
Phone Number:
Email:
Social Security Number:
Are you between the ages of 18 – 24?
Yes
No
Are you a Veteran?
Yes
No
Income Information
List Household Members
(Include yourself)
Relationship Date of Birth
Monthly Income
(Income including: Earned & Unearned Income,
Unemployment Comp, SSI, RSDI, etc)
$
$
$
$
$
$
If no income, how do you support yourself?
Employment Information
Are you currently employed?
Yes
No
If employed, list current place of employment:
Are you presently laid-off?
Yes
No
If yes, list company:
Have you received notification of layoff?
Yes No
If yes, list company:
Career/Education Goal
What is your education status?
HS Grad /GED
ABLE
Vocational School
Associate Degree
Bachelor Degree
Certificate
Credential
Some College ____________________________
If you have not graduated or received your High School Equivalency, what is the highest grade completed?
What is your employment or career goal?
Are you currently enrolled in school?
Yes
No If yes, where/what program:
Where would you like to receive this training?
Did you complete any type of assessment at the training institution or career placement
Yes
No
(Example: WorkKeys, Compass, TABE, SLE)
Cost of this training:
Start date of the training:
Anticipated end date of the training:
What kind of jobs would you be qualified for after completing this training?
What skills, experience or training do you currently have that would make you a good candidate for this field?
What is the entry-level salary/wage rate for jobs in this field?
What is the employment outlook, including projected annual openings, for this type of work in the local job market?
How far are you willing to travel/drive for a position in this field?
Please indicate the Job Search skills that you need assistance with:
Basic Computer Word Excel Internet Job Search Resume Cover Letters Interviewing
Budgeting Other ___________________________________________________________________________________
What will be your job search strategy following the training?
Needs & Barriers
Disabled
Older Worker
Substance Abuse
Limited Proficiency
Offender
Basic Literacy
Learning Disability Poor Work History Homeless TANF Exhausted School Drop-out
Mental/Physical Limitations Past IEP (Individual Education Plan)
Will you need child care now or in the future?
Yes
No
What is your emergency plan when the child(ren) is ill and cannot stay with child care provider?
Can you provide your own transportation?
Yes
No
If no, who will be responsible for driving you back & forth to training/work?
Financial Aid (Education/Training Only)
PELL Amount awarded
$
Employer Scholarship or Contribution
$
Student Loans
$
Other Resources:______________
$
Total Amount Awarded
$
Are you default on a previous Student Loan?
Yes
No
If yes have you been making payments?
Yes
No
**Documentation of last 6 months of on-time payments must be
provided for default student loans
________________________________________________________ ________________________________
Customer Signature Date
________________________________________________________ ________________________________
Case Manager Signature Date
OMJ Form 900-03/Revised 11/2017
Job History
Name _______________________________________ Last four SSN xxx-xx ___________
List Employment History
* Begin with most current employment
Employer:
City & State:
Hours Worked Per Week:
Start Date: Starting Wage:
End Date: Current/Ending Wage:
Job Duties:
Reason For Leaving:
Employer:
City & State:
Hours Worked Per Week:
Start Date: Starting Wage:
End Date: Current/Ending Wage:
Job Duties:
Reason For Leaving:
Employer:
City & State:
Hours Worked Per Week:
Start Date: Starting Wage:
End Date: Current/Ending Wage:
Job Duties:
Reason For Leaving:
Employer:
City & State:
Hours Worked Per Week:
Start Date: Starting Wage:
End Date: Current/Ending Wage:
Job Duties:
Reason For Leaving:
I have never been employed. Initials__________ Date______________ OMJ Form 900-06/Revised 11/2017
Employer Contacts for the Last 30 days
Date Employer
Application method
(online, in person, etc)
What position did you
apply for?
Do you currently
have the
qualification(s)
for this position?
Response from
Employer
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Signature _________________________________________________ Date _____________________
OMJ Form 900-07/Revised 11/2017
Needs and Resources Form
Return to:
Student Name:
Last 4 SSN:
School:
Program:
I authorize OhioMeanJobs - Allen County and the Financial Aid Officer at the above named school to exchange financial,
academic, and other information necessary in regard to my education/training program.
Participant Signature: ____________________________________ Date: _____________
FINANCIAL AID OFFICER – PLEASE COMPLETE AND RETURN
* Please asterisk tuition-specific aid
Needs analysis:
Financial Aid
FALL WINTER SPRING SUMMER
PELL-SEOG
OIG
Scholarships
Other Aid
Other Aid
TOTAL
A. Student’s Cost of Attendance for this term;
Include all expenses
, not just educational
$
B. Total Resources for this Session/Semester (From Grid Above)
$
C. Remaining Unmet Need for this Quarter/Session/Semester (A minus B)
$
**No financial aid information on file as of this date ______________
Comments:________________________________________________________________________
_______________________________________________ _________________
Financial Aid Officer’s Signature Date
OMJ Form 900-10/Revised 11/2017
Session / Semester Breakdown
List all courses required and credit hours
**Highlight remedial or pre-requisites courses
Term:
Term:
Term:
Term:
Course
Credits
Course
Credits
Course
Credits
Course
Credits
Term:
Term:
Term:
Term:
Course
Credits
Course
Credits
Course
Credits
Course
Credits
Note: If additional sessions are required please use the space below.
Term:
Term:
Term:
Term:
Course
Credits
Course
Credits
Course
Credits
Course
Credits
Comments: ___________________________________________________________________________________________________________________________________
I give my permission for this information to be released to OhioMeansJobs – Allen County for the purpose of evaluation of my educational needs.
______________________________ ___________________ ________________________________________________
Student Signature/Date Academic Advisor Signature /Date
OMJ Form 900-11/Revised 11/2017
Institution:
Student Name:
Major/Degree Expected: Cost Per Credit Hour:
Begin Date:
Date of Graduation:
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Customers Attending, Enrolled Or Accepted Into EducationTraining Informational Packet (Allen County Ohio)

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Completed 18 July 2020

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