Information and Documents needed for work2future Welcome Orientation
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1 San Jose One-Stop Campbell One-Stop Gilroy One-Stop Morgan Hill Satellite 1601 Foxworthy Ave 2450 S. Bascom Ave 7800 Arroyo Circle Ste. A Crest Ave San Jose, CA Campbell, CA Gilroy, CA Morgan Hill, CA Information and Documents needed for work2future Welcome Orientation A Review the Welcome Packet Complete Customer Information Form in its entirety REGISTER ON CalJOBS SM prior to coming to orientation Attach a copy of your resume Review Center Rules of Conduct Please arrive 15 minutes prior to your scheduled welcome orientation time If you fail to bring in the following required documents you will be rescheduled B To be eligible for work2future services you must provide the following documents, which must be Original And Unexpired: 1. Proof of your identity (birth date/age) and right-to-work (employment eligibility) in the United States Review LISTS OF ACCEPTABLE DOCUMENTS (see attachment) One document from List A OR One document from List B And One document from List C Examples include: Drivers License And Social Security card OR U.S. Passport C Provide the following Additional Documents, if they apply to your situation: 2. If terminated or laid-off within the last two years: Notice of Layoff 3. Documentation for Unemployment Insurance (U.I.) benefits: U.I. Award Letter/Extension Letter AND U.I. continued claim form/stub OR Notice of Unemployment Insurance Exhaustion of benefits OR Unemployment Insurance Ineligibility (print-out) 4. If you are a male born after January 1, 1960, your selective service status will be verified 5. If you are a Veteran, documentation from the Department of Defense or Veterans Affairs, such as DD-214 or Veterans Administration Letter / Records IF YOU REQUIRE A SPECIAL ACCOMMODATION E.G. ASSISTIVE TECHNOLOGY FOR VISUAL OR HEARING IMPAIRMENT PLEASE INDICATE THIS ON THE CUSTOMER INFORMATION FORM AN EQUAL OPPORTUNITY PROGRAM Auxiliary aids and services available upon request to individuals with disabilities
2 4-Step Process to access work2future services Step 1 work2future Orientation an overview of services offered at work2future Step 2 Verification of Right-to-Work Documents and completion of documents Step 3 Completion of enrollment application / Issue work2future ID Passport Card/Review Center Rules /Skills Assessment Step 4 Meet with a Talent Coach to develop an Individual Employment Plan (IEP). If you do not access work2future services for a 90-day period you will need to repeat the application process. work2future One-Stop Center San Jose 1601 Foxworthy Avenue San Jose, California (408) work2future One-Stop Center Campbell 2450 S. Bascom Avenue Campbell, California (408) work2future One-Stop Center Gilroy 7800 Arroyo Circle Ste. A Gilroy, California (408) work2future Satellite Office Morgan Hill Crest Avenue Morgan Hill, CA (408) AN EQUAL OPPORTUNITY PROGRAM Auxiliary aids and services available upon request to individuals with disabilities
3 CUSTOMER INFORMATION Name : Contact Number: Date: Are you currently working* Yes No If YES what is your current occupation : Were you laid off within the last 2 years? Yes No If YES Date of Layoff Employer at the time of Layoff? Hourly Wage at time of employment: $ When you were laid off, did you have an overview of services from EDD, work2future or Nova Yes No Income for the past 6 months (Gross) $ DO NOT INCLUDE UNEMPLOYMENT INSURANCE (if applicable) Educational Level: GED High School Diploma AA BA/BS MA/MS PhD Highest grade completed if not high school graduate: Have you received WIA funded/or any other training in the past? No Yes If Yes, Name of school and type of training: What type of Work or Occupation are you looking for? 1. Experience: years months 2. Experience: years months 3. Experience: years months (Class A) (Class B) (Class C) (Class M) California Driver s License: Truck Bus Car Motorcycle None Will you provide references if requested Yes No Are you willing to relocate? Yes No Do you want perspective employers to view your resume? Yes No EMPLOYMENT HISTORY Please provide the last 10 years of employment Employer Name: Phone: Wages (hourly) Address/Zip: City: State: Industry: Job title: Occupation: From: To: Years # Months # Certificate/License Required: Have Certificate/License Certificate/License Description: Summary of Job Duties: Yes No Reason for Leaving: Page 1 of 3 Rev. 1/12
4 Employer Name: Phone: Wages (hourly) Address/Zip: City: State: Industry: Job title: Occupation: From: To: Years # Months # Certificate/License Required: Have Certificate/License Certificate/License Description: Summary of Job Duties: Yes No Reason for Leaving: Employer Name: Phone: Wages (hourly) Address/Zip: City: State: Industry: Job title: Occupation: From: To: Years # Months # Certificate/License Required: Have Certificate/License Certificate/License Description: Summary of Job Duties: Yes No Reason for Leaving: Do you require any special accommodation? If YES, Please explain below: How did you hear about work2futre? Please explain below: Rev. 3/12
5 LISTS OF ACCEPTABLE DOCUMENTS All documents must be unexpired LIST A LIST B LIST C Documents that Establish Both Identity and Employment Authorization 1. U.S. Passport or U.S. Passport Card 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551) 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machinereadable immigrant visa 4. Employment Authorization Document that contains a photograph (Form I-766) 5. In the case of a nonimmigrant alien authorized to work for a specific employer incident to status, a foreign passport with Form I-94 or Form I-94A bearing the same name as the passport and containing an endorsement of the alien's nonimmigrant status, as long as the period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI OR Documents that Establish Identity 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 3. School ID card with a photograph 4. Voter's registration card 5. U.S. Military card or draft record 6. Military dependent's ID card 7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document 9. Driver's license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: 10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record AND Documents that Establish Employment Authorization 1. Social Security Account Number card other than one that specifies on the face that the issuance of the card does not authorize employment in the United States 2. Certification of Birth Abroad issued by the Department of State (Form FS-545) 3. Certification of Report of Birth issued by the Department of State (Form DS-1350) 4. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal 5. Native American tribal document 6. U.S. Citizen ID Card (Form I-197) 7. Identification Card for Use of Resident Citizen in the United States (Form I-179) 8. Employment authorization document issued by the Department of Homeland Security Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274) Form I-9 (Rev. 02/02/09) N Page 5
6 W2FWIB OD; Ver To: All work2future providers of services From: Christopher Donnelly, Assistant Director Effective Date: April 1, 2009 Release Date: Revised/Released: SUBJECT: NONDISCRIMINATION AND EQUAL OPPORTUNITY PROCEDURES NOTICE Reference: WSD07-6, January 16, 2008; Workforce Investment Act; Title 20 CFR OPERATIONAL DIRECTIVE NOTICE TO INTERESTED PARTIES: 1290 Parkmoor Avenue San Jose CA Bascom Avenue, Campbell, CA Arroyo Circle, Gilroy, work2future provides program services and/or training made possible by WIA and Wagner-Peyser funding. work2future staff, its partner staff, its contractors, and any person or agency receiving funding from work2future must comply with the procedures and reporting requirements of the State Directive referenced above. All providers of services must establish, document, and implement procedures as specified in these Directives. Persons filing a complaint (complainants) shall be free from restraint, coercion, reprisal, or discrimination; both state and federal law prohibit retaliation against a complainant. If you want to file a complaint, please see the receptionist at the front desk to receive a copy of the Nondiscrimination and Equal Opportunity Policies and Procedures and all relevant forms. All necessary information to contact the Customer Relations Manager will be made available. The Customer Relations Manager will provide technical assistance to the complainant regarding how to file or amend the complaint and will, additionally, provide clarifications and interpretations of relevant provisions Nondiscrimination and Equal Opportunity Notice: It is against the law for any recipient of federal financial assistance to discriminate: Against any individual in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief. Against any beneficiary of programs financially assisted under Title I of the Workforce Investment Act of 1998 (WIA), on the basis of the beneficiary s citizenship/status as a lawfully admitted immigrant authorized to work in the United States, or his or her participation in an WIA Title I, financially assisted program or activity. As recipients, work2future, its contractors, and its vendors may not discriminate in any of the following areas: (1) deciding who will be admitted, or have access to, any WIA Title I financially assisted program or activity; (2) providing opportunities in, or treating any person with regard to such a program or activity; or (3) making employment decisions in the administration of, or in connection with, such a program or activity. If you think you have been subjected to discrimination under a WIA Title I financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with work2future s Customer Relations Manager for immediate referral to the City of San Jose s Equal Opportunity (EO) Officer, or you may file your complaint with: The Civil Rights Center (CRC) U. S. Department of Labor 200 Constitution Avenue, NW, Room N-4123 Washington, DC If you file your complaint with work2future/city of San Jose, the Local Workforce Investment Area (LWIA) is allowed 90 days to issue a written Notice of Final Action before you file a complaint with the CRC. If the LWIA does not give you a written Notice of Final Action within 90 days of the day on which you filed your complaint, you do not have to wait for the LWIA to issue that Notice before filing a complaint with CRC. However, you must file your CRC complaint within 30 days of the 90-day deadline (in other words, within 120 days after the day on which you filed your complaint with work2future). If the LWIA does give you a written Notice of Final Action on your complaint, but you are dissatisfied with the decision or resolution, you may file a complaint with CRC. You must file your CRC complaint within 30 days of the date on which you received the Notice of Final Action. My signature below certifies that I have read and understand the Nondiscrimination and Equal Opportunity procedure for WIA programs operated by work2future; if requested, I have received a copy of the referenced Employment Development Department s Nondiscrimination and Equal Opportunity Procedures Directive. Participant's Printed Name: Badge/Application #: Participant s Signature: Date:
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8 Welcome to the work2future One-Stop. To assist you in your career search and enhance the overall experience for you and all our customers, please observe the following Rules of Conduct specific to use at each One-Stop facility: No weapons of any kind are permitted in the One-Stop. 1. The One-Stop and its equipment are for job search purposes only. Phones are not to be used for personal phone calls. 2. For safety reasons, children are not allowed in the One-Stop 3. Do not modify or alter job postings, equipment, flyers, or signage located in the One- Stop. 4. Keep personal conversation to a minimum and at low volume. Abusive or disrespectful language or behavior will not be tolerated. 5. Keep cell phones turned down or on vibrate. All personal calls are to be made and answered outside of the Talent Marketing and Welcome areas. 6. Materials may not be posted or distributed without One-Stop management approval. 7. Unemployment Insurance calls can only be made in the designated area. 8. Please leave your work area clean. 9. The One-Stop will provide up to ten (10) photocopies and up to five (5) faxes per day. Please ask staff for assistance. Rules for use of One-Stop Talent Marketing Area (TMA) computers You can sign up for a two-hour session each day. If computers are available, you may sign up for more than one session per day. For computer problems please contact TMA Reception Staff. You may sign up for a single specific two-hour session up to five (5) days in advance. Do not download any personal information to the computers. Do not modify or alter the computers. Computers may not be used to view, download, or print profanity or discriminatory or pornographic material. Food and drinks are not permitted in the TMA. THESE RULES OF CONDUCT ARE INTENDED TO ENSURE ALL CUSTOMERS HAVE AN OPTIMAL EXPERIENCE. IF YOU CHOOSE NOT TO COMPLY WITH THESE RULES OF CONDUCT, STAFF HAS THE RIGHT TO ASK YOU TO LEAVE THE ONE-STOP. THANK YOU. Please sign (acknowledgement of rules): mm1_3_12 We encourage the use of online comment cards available at the Blue Kiosks.
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POLICIES RELATED TO JOB ORDERS Federal minimum wage - The Federal minimum wage is $7.25 per hour with health insurance benefits provided by employer and received by employee; minimum wage is $8.25 per
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Social Security Number. mo. day year City State Country Yes No
UndergradUate application for admission Personal Data Mr. Mrs. Dr. Miss Ms. Last Name First Middle Suffix Home Address Home Phone Street City State Zip Area Mailing Address (if different from above) Cell
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If Renewal Date (listed on license) is: The NEW date for renewal is: 6/30/2010 4/1/2010 6/30/2011 4/1/2011 6/30/2012 4/1/2012 6/30/2013 4/1/2013
Janice K. Brewer Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix. AZ 85014-3655 Phone (602) 771-7800 Fax (602) 771-7888 E-Mail: [email protected] Website: www.azbn.gov
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