MANIILAQ ASSOCIATION EMPLOYMENT & TRAINING

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1 Direct Employment (DE) Funds: Provides assistance with pre-employment needs such as work-clothes, tools, utilities, deposit and first month's rent, groceries, and basic household needs not to exceed $4000. Assistance is provided to Tribal members in Amber, Shungnak, Deering, Kivalina, Noorvik and Kobuk who are new employees that have received an offer of employment and have NOT received their first paycheck. Tribal members from other tribes may receive assistance with certain restrictions. If you live in Kotzebue, regardless of the tribe you are enrolled in, you will have to apply for Direct Employment assistance from the Kotzebue IRA. This program provides funds to assist Native people acquire job skills necessary for full-time employment including testing, counseling, guidance, training, apprenticeship, on-the-job training and supportive services such as workrelated clothing, transportation, tools and related expenses. Funding for Direct Employment will not exceed $4000 toward current month s basic living expenses, i.e., rent, utilities, work clothes or tools and $500 of which to be used to purchase food and household goods. Required Documents (to attach to application) Note: Applications without documentation will not be Accepted! Complete, signed Direct Employment Application Tribal IRA enrollment verification Copy of current State ID or Drivers License Copy of Social Security Card Individual Self Sufficiency Plan - ISP Attached Verification of Employment form- Form Attached Job offer letter Rental Agreement (if needed) Proof of needing work-clothes, tools, utilities, or training expenses. Responsibility of Applicant: It is the applicant s responsibility to contact the Maniilaq Employment & Training office to ensure his/her application is complete and being processed. If your application is incomplete, we will contact you to inform you of what s needed, and you will have 30 days to get the required information back to us. If you have not contacted us after that time period, your application will be denied. Goals and Objectives of our Program: The goal of Maniilaq Employment & Training Program is to assist in providing training to the people of the Northwest Arctic region into gainful employment and to be economically self-sufficient. Our case workers go above and beyond to assist each client in funding resources and also by providing case management, need assessments which identify skills, work experience, educational needs, and training needs to achieve employment. Eligibility: Tribally enrolled in one of the six villages: Amber, Shungnak, Deering, Kivalina, Noorvik and Kobuk or Denied DE assistance from another tribal entity. Be a resident of one of the 6 villages listed above Applicants must meet the Eligibility requirements from this application Have applied for other funding/assistance and or have been denied by another tribe entity offering the Direct Employment funds. Notice to Applicant: Maniilaq Association Direct Employment Program, is not automatic and is not an entitlement. You must apply, and provide all documentation to be approved. All applications for assistance will be reviewed and acted upon within 14 days of receiving all required documents. If a decision cannot be made within a 14 day period, a letter will be sent to the applicant explaining the reasons for delay. Incomplete applications will be held for 30 days. If all required documentation is not received within that time period, your application will be denied. P: (907) Fax: Page 1 of 6

2 Applicant Information Name: First Middle Last Social Security Number Maiden Name: Or other Names Used: Date of Birth: Male Female Mailing Address: City: State: Zip: Physical Address: City: State: Zip: Home/ Cell Phone: Message Phone: Address: Veteran: No Yes Registered with selective Services? Yes No N/A Tribal Village IRA you are Enrolled in: Attach Copy of Tribal Card Applicant Status: Single Married Separated Divorced Widowed Single Parent 2Parent Family Head of Household Dependent Grandparent/Guardian Current Residency: Own Home Rent Home/Apartment With Relatives/friend Rent Room Other: Household Information List all persons currently living permanently in the household with the information requested for each person (you, spouse/significant other, children, parents, grandparents, aunts, uncles, etc.). Name Relation to Head Birth Date Self Tribal Enrollment Village IRA Social Security # How many persons live in the house? Adults Children Are you or any member of your household a shareholder of a Native Corporation? Yes No If yes, list the names of household members and Corporation(s): Name: Native Corporation # of Shares P: (907) Fax: Page 2 of 6

3 Barriers to Self Sufficiency (Check all that may apply): Currently employed/low income BIA General Assistance Recipient Last date of employment Lack significant work history Limited English Proficiency Criminal History Lack of Child Care Not at age appropriate H.S. grade level Domestic Violence No Driver s License Foster Care Child Support Issues Public Assistance (Food Stamps, GA, etc.) Long-Term TANF(30 Months)/ATAP Recipient TANF Recipient Unemployed 15 + weeks Substance Abuse Issue Reading Skills below 7 th grade Math skills below 7th grade Lack of Transportation High School Dropout/no GED Single parent Disabled Individual Homelessness Pregnant/Parenting Teen Lack of Degree Educational Background and Employment Information Employer: Phone: Job Title: Length of Employment: Educational Background High School Attended Highest Grade Completed: 9 th 10 th 11 th 12 th Address: City: State: Zip: Date of Graduation: Date received GED: Last Year Attended School: Employment History Employer Name: Job Title: Dates Employed: (from/to) Address: Wage: Hours Per Week: Reason For Leaving: Employer Name: Job Title: Dates Employed: (from/to) Address: Wage: Hours Per Week: Reason For Leaving: P: (907) Fax: Page 3 of 6

4 Authorization for Release of Information I, (applicant), hereby authorize the release of information requested by the Program. The requested information shall be used solely in the administration of Employment & Training and will not be release to any other person or agency outside the Employment & Training Program or its agents. I hereby authorize Maniilaq Association Employment & Training Program to obtain and exchange information related to my applications to participate in their programs. And, to arrange for such participations based on my employability assessment and plan to employment related services and activities. This release of information shall be in effect while I am an applicant or recipient of Employment & Training benefits. Persons or organizations that may be contacted include, but are not limited to: the Department of Law, the Department of Public Safety, the Department of Fish & Game, the Department of Labor, the Department of Military Affairs, Alaska State Housing Authority, Social Security Administration, local and tribal governments, public assistance program contractors, stock and grantees, Health Care Providers, Tax Assessors, Financial Institutions, Native Corporations, Stock Brokerage Firms, Landlords, Employers, School Authorities, private individuals and all departments and programs within and administered by the Tribal Government Services. Applicant Print Name Applicant Signature Social Security Number Date of Birth Date of Applicant Signature Privacy Act Notice (PL ) The law requires every federal agency maintaining records about people to inform each person, from whom information is obtained, about the nature and purpose of the record. This includes employment and vocational training records maintained by the Maniilaq Association Higher Education and Career Development Department, as we have contracts with the U.S. Department of the Interior, Bureau of Indian Affairs; the U.S. Department of Labor, Division of Indian and Native American Programs; and the Department of Health and Human Services, Administration for Children and Families. The purpose of the forms and questions asked of you is to enable us to organize, staff and provide comprehensive employment and vocational training services to the people we serve. In most instances you may choose not to answer the questions if you so desire, without risk to your rights and entitlements. However, by giving the information requested of you, we will be able to carry out our responsibilities to you more effectively, and render better services. Information provided by you is held in confidence, and is only available to Maniilaq employees who have a need to know in the performance of their duties. In addition, certain data may be provided to local, state, federal, and other health and welfare facilities and agencies on a needto-know basis for continuation of services, to provide for a proper evaluation of your case file and for reporting as required by the aforementioned federal agencies. Data may also be made available to approved accreditation agencies and performance standard review organizations for evaluation of our system; to authorized research personnel with an approved research protocol when no personal identification data is included, and to the Department of Justice or other law enforcement agencies. I CERTIFY THAT I UNDERSTAND THE AUTHORITY BY WHICH INFORMATION IS ASKED OF ME, AND THE PURPOSE AND USE TO WHICH THAT INFORMATION WILL BE PUT, AND THAT PROVIDING ANY INFORMATION IS VOLUNTARY ON MY PART. Applicant Signature Date P: (907) Fax: Page 4 of 6

5 INDIVIDUAL SELF-SUFFICIENCY PLAN (ISP) In order for your application to be processed, this form must be completely filled out Participant Name: Date of Plan: Eligibility Review Date: Are you currently employed? If yes, where? How long? Yes No Highest grade completed: Date graduated/received GED: Date last attended school: Short-term goals: WHAT IS/ARE YOUR GOAL(S) TO OBTAIN SELF-SUFFICIENCY? Long-term goals: STEPS NEEDED TO ACHIEVE SELF-SUFFICIENCY Work Activities: Education/Training: Other Activities: Employment: Full-time Part-time High School Diploma Life Skills Instruction Job searching GED Parenting Skills Workshop Volunteer Work Experience ESL(English as a 2 nd Language) Childcare Assistance Job Sampling or Job Shadowing Adult Vocational Training Child Support On-the-job training Literacy Improvement Substance Abuse Assessment Job Readiness Employment Counseling Substance Abuse Treatment Other: Other: Other: SELF-SUFFICIENCY ACTIVITY PLAN AND GOALS (CURRENT AND/OR FUTURE GOALS ONLY) GOAL #1 START DATE DATE TO BE ACHIEVED ACTUAL COMPLETION DATE Step 1. Step 2. Step 3. GOAL #2 START DATE DATE TO BE ACHIEVED ACTUAL COMPLETION DATE Step 1. Step 2. Step 3. GOAL #3 START DATE DATE TO BE ACHIEVED ACTUAL COMPLETION DATE Step 1. Step 2. Step 3. I understand that the purpose of this Individual Self-Sufficiency Plan is to meet the goal of employment through specific action steps and I am required to follow the steps developed in the ISP. I must participate in work activities and/or other activities and referrals developed in this plan that will promote my selfsufficiency and failure to do so may constitute suspension from the Employment & Training Program for a period of 60 days, but not more the 90 days. I also understand that if there are any changes to be made that I will contact my Case Worker in a timely manner to ensure my success in the Employment & Training Program. Signature of Applicant Date Employment & Training Staff Date P: (907) Fax: Page 5 of 6

6 Verification of Employment- To be filled out by new Employer Submit this form with Completed Application for it to be Processed Applicant s Name The individual named above has applied for services through Maniilaq Association s Employment & Training Program. Please provide the following information for verification. Employer Organization Name: Employer Address: Phone Number: Fax Number: Applicant s Job Title: Date of Hire: Employment Start Date: Disbursement date of first check: Hourly Salary: Hours Per Week: Please indicate applicant s employment status: Pre-employment interview/orientation dates: Pre-employment training dates: Full-time, permanent Full-time, temporary. If temporary, what is the duration of employment Part-time, permanent Part-time, temporary. If temporary, what is the duration of employment Other, explain: weeks/months. weeks/months. Does position offer fringe benefits? Yes / No Yes / No Does this position require clothing and/or tools not provided by the employer? If so, please list needed items. Include itemized clothing/tool list and price: Signature of Employer _ Date: Printed Name Title: Phone: P: (907) Fax: Page 6 of 6

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