EMPLOYED WORKER TRAINING APPLICATION

EMPLOYED WORKER TRAINING APPLICATION CareerSource Escarosa, Inc. 3670 North L Street Pensacola, Florida 32505 Phone (850) 473-0939 Fax (850) 473-0935 www.careersourceescarosa.com

Employed Worker Training Program Guidelines & Application The Employed Worker Training Program is funded by the Federal Workforce Investment Act (WIA) funding. Local EWT funds and services are administered by CareerSource Escarosa, Inc. (Regional Workforce Board #1) within Escambia and Santa Rosa Counties, Florida. The EWT Program serves as a means to assist employers with training expenses associated with skills upgrade training for full-time employees. Program Guidelines Applications for the CareerSource Escarosa, Inc. EWT Program are open to Escambia and Santa Rosas County companies meeting the guidelines listed below. BUSINESS APPLYING FOR FUNDING: Must be a for-profit or not-for-profit business and have been in operation in Florida for a minimum of one year prior to application date to be eligible for grant funding Must demonstrate financial viability and must be current on all state tax obligations, as applicable. Must comply with the nondiscrimination and equal opportunity provisions of Section 188 of the Workforce Investment Act of 1998;Title VI of the Civil Rights Act of 1964,Section 504 of the Rehabilitation Act of 1973;Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972, and with 29 C.F.R. Part 37 Must have at least one full-time employee Must provide 50% in-kind or cash match of total training dollar amount being requested. Can only be considered for an award every other program year. PRIORITY WILL BE GIVEN TO: Businesses with 25 employees or less Businesses in rural areas Businesses in distressed inner-city/enterprise zone areas Businesses in a qualified targeted industry Businesses whose grant proposals represent a significant upgrade in employee skills Businesses whose grant proposals represent a significant layoff avoidance strategy. TRAINING SERVICES (NOTE: All training must be completed by June 30 th of any current year, unless otherwise approved by Workforce Escarosa, Inc: Can be provided through Florida s public or private educational institutions, private training organizations, trainers employed by the business, or a combination of training providers. Private postsecondary institutions and private training providers may be utilized only upon a review that includes, but is not limited to, accreditation and licensure and prior approval by CareerSource Escarosa, Inc. Can be conducted at the business s own facility, at the training provider s facility or at a combination of sites REIMBURSABLE TRAINING EXPENSES: Instructors /trainers salaries actual amount for vendors or maximum $25/hour for internal instructors Curriculum Development Textbooks/Manuals NON-REIMBURSABLE TRAINING EXPENSES: Trainees wages Purchase of capital equipment Purchase of any item or service that may possibly be used outside of the training project Travel expenses of trainers or trainees On the Job Training expenses Assessment, testing or certification fees

GRANT AWARDS: Businesses approved for funds enter into a contract with CareerSource Escarosa, Inc., which commits the business to complete the training project as proposed in their application. Any business approved for a CareerSource Escarosa, Inc. award, that is a recipient or sub-recipient of Federal funding of $500,000 or more in a fiscal year, will be required to furnish an independent financial and compliance audit. The company is responsible for the cost of the audit. EWT funds cannot be used to cover audit costs. Approved budget items are reimbursed upon presentation of adequate documentation of the training and evidence that the training was successfully completed (copy of certificates provided to trainees). Payment to the employer/training entity can be made on a cost per trainee versus a line-item reimbursement. Businesses are required to provide a matching contribution to the training project. Businesses are required to provide a minimum of 50% of the requested direct training costs, i.e. instructors wages/tuition, curriculum development and textbooks and manuals. For performance tracking measures, businesses, are required to submit specific information for employees participating in training activities which includes, but is not limited to, trainees names, social security numbers, dates of birth, race, citizenship, legal authority to work in U.S. status, male selective service registration status, trainee wages/payroll statements, trainer wages/payroll statements, etc. In most cases, much of that information is available via a company s Human Resources office and can be gathered with minimal inconvenience to the employee/trainee. (See Attachment I) CareerSource Escarosa will provide eligibility determinations for all trainee participants. Businesses must submit monthly reimbursement requests with required documentation or monthly training status reports by the 20 th of the month for the previous month s training. PROJECT COMPLETION: With the high demand and limited funding available, all applications will be evaluated to leverage other state, federal and private funds with CareerSource Escarosa, Inc. Employed Worker Training funds. All grant projects shall be performance based with specific measurable performance outcomes -- including the completion of the training project and number of employees trained. Final payment for businesses receiving EWT awards will be withheld until the final report is submitted and CareerSource Escarosa, Inc. verifies that all performance criteria specified in the EWT contract have been achieved. Businesses shall provide sufficient documentation to CareerSource Escarosa, Inc. for identification of all employee participants for calculation of performance measures required by WIA and any other outcomes deemed pertinent by the EWT Program administrator. All EWT training must be completed in accordance with the schedule of events to be included in the EWT contract.

Application Instructions DETACH and complete the attached EWT Program Application. Any information or documentation that cannot be supplied in the provided space should be identified by the relevant question number and attached to the back of the application form. Submit the original signed completed application and one copy to: Employed Worker Training Program CareerSource Escarosa, Inc. Attention: Susan B. Nelms, Executive Director 3670 North L Street Pensacola, Florida 32505 PLEASE SUBMIT YOUR APPLICATION AT LEAST 30 DAYS PRIOR TO THE DESIRED START DATE OF TRAINING. If you have any questions or need assistance in completing the application, please contact Eric Flora at eflora@careersourceescarosa.com

Employed Worker Training Program Grant Application SECTION 1. Company Information. Admin. Only IN IWT # Region# Company Name: Street/Mailing Address: City: ZIP: County: Company Contact Person: Title: Phone: Ext. Fax: Email Address: Website Address: Date of Inception: Years in Business: Total # Full-time Employees at this location: Legal Structure of Business: Sole Proprietor Partnership Corporation Non-profit Leased Other - Employer s Federal ID #: Unemployment Comp ID #: Florida Sales Tax Reg. #: Primary NAICS and or (SIC) Code: Is your company current on all State of Florida tax obligations? YES NO Please estimate the total amount your company will spend on training in the current year Is your company receiving/applying for other public training funds? YES NO If yes explain: Is your company currently receiving Federal funding from other sources that require the company to comply with The Federal Single Audit Act? (please refer to EWT guidelines concerning this issue) YES NO If yes, please state the source(s) and $ amount(s): Description of your business, product(s) and/or service(s): Amount of Grant Request: Training Start Date (on or after 7/1/07): Number of FT Employees to be Trained: (must be Florida residents) Training End Date This company is minority owned. Please check the appropriate box. Native/American owned African/American owned Asian/American owned Women-owned Hispanic/American owned Other minority owned (specify): Our company is located in: Distressed inner-city area HUB Zone Brownfield Enterprise Zone (provide EZ Number) Rural area

SECTION 2. Training Provider Information: The training provider(s) will be: Public training institution Private training institution Company employee Private instructor Training will be delivered: On-site At the training institution At a remote location Name of Training Provider(s): Name of Training Provider contact: Phone: Address: City: State: ZIP: SECTION 3. Training Project Information: Description of the proposed training project provide number of trainees, job titles, departments, broken out by type of training, number of hours of training, training provider, cost of instruction/tuition, any resulting certifications, etc. Example: 1. (2) Plastics Operators Production Department Injection Molding Skills 28 contact hours each Training Provider: Society of Plastics Industry via satellite downlink at company site $500 per Trainee National Certification in Plastics NCP Certified Operator 2. (10) Managers Production, Quality Assurance, and Accounting Departments New Vision Tracking Software for Manufacturers Training Provider: Company employee (4) sessions, 6 hours each = 24 hours No certification

SECTION 4. Training Program Budget Please use this as a guide. Show all formulas used to calculate totals as indicated. BE SPECIFIC. Note: Training funds cannot be used to reimburse any training costs incurred before the grant is approved. Please take this into account when developing your budget and timeline. A. BUDGET CATEGORY B. EWT ASSISTANCE REQUESTED C. * EMPLOYER CONTRIBUTION D. TOTAL (B. + C.) 1. Instructor Wages/Tuition (This information should reconcile with Section 3. Training Project Description) Example: 1) Injection Molding $500 X (5) = $2500 2) New Visions $25/hr X 24 hours = $600 SUB TOTAL = $3,100 2. Curriculum Development (please list number of hours per course) 3. Manuals/ Textbooks (itemize) Example: (10) New Vision Manuals @ $30 each = $300 4. Training Equipment Purchase (must be employer contribution) Cannot fund with 5. Other Costs (describe) a) b) 6. Facility Usage (if training takes place at company site) Cannot fund with 7. Travel, Food, Lodging Cannot fund with 8. Trainee Wages (including benefits) Cannot fund with 9. Sub Total 10. Indirect Costs Cannot fund with 11. TOTALS EWT Cost per Trainee =Line 11 Column B divided by Number of Trainees Employer Contribution Ratio =Line 11 Column C divided by Line 11 Column B *Note: Businesses are required to provide a minimum of 50% of the requested direct training costs, i.e. instructors wages, curriculum development and materials & supplies. Other examples of employer contribution include, but are not limited to, expenses associated with additional instruction/tuition, curriculum development, materials/supplies; the use of space and equipment during the training project (please show calculation used to assign a value); and trainee wages (including benefits) of employees during training.

SECTION 5. Anticipated Outcomes of the Training Project Please check the boxes that apply to the anticipated outcomes of the proposed training project. Attach a brief statement to this application for each checked box explaining "how" and/or "why" this training would result in the specific outcome. Will save jobs within our company Will create openings in entry-level positions Will improve the long-term wage levels of trainees Will improve the short-term wage levels of trainees Will create new jobs within our company Would help prevent company from having to relocate operations Will lower employee turnover in our company Critical to the long-term viability of our company Critical to the short-term viability of our company Will make this location more competitive within company Will assist in the training of veterans Will assist in the training of minorities Will assist in the training of the disabled Will assist welfare to work participants Will increase the profitability of our company Important to the stated mission of our company Will be an important component of our company s overall workforce employee development efforts Will assist in the improvement of international trade opportunities SECTION 6. Certification by Authorized Company Representative [ NOTE: The individual signing the application below must have authority to enter into contracts on behalf of the applying company. ] As an authorized representative of the company listed above, I hereby certify that the information listed above and attached to this application is true and accurate. I am aware that any false information or intended omissions may subject me to civil or criminal penalties for filing of false public records and/or forfeiture of any training award approved through this program. Signature: Print Name: Title: Date: PLEASE ALLOW AT LEAST 15 BUSINESS DAYS FOR YOUR APPLICATION TO BE PROCESSED. Mail original and 1 copy to: Employed Worker Training Program CareerSource Escarosa, Inc. 3670 North L Street Pensacola, Florida 32505 or via email to: eflora@careersourceescarosa.com How did you learn about the Florida Incumbent Worker Training Program? APPLICATION PREPARED BY: (if different than authorized company representative above) Name: Email: Address: Title: Company: Phone:

Equal Opportunity Assurance Statement As a condition of the proposal for this grant, the Applicant assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA) which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I B financially assisted program or activity; 2. Title VI of the Civil Rights Act of 1964, as amended, which prohibits discrimination on the basis of race, color, and national origin; 3. Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination against qualified individuals with disabilities; 4. The Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age; and 5. Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex in educational programs. The Applicant also assures that it will comply with 29 C.F.R. Part 37 and all other regulations implementing the laws listed above. This assurance applies to the grant applicant s operation of the WIA Title I financially assisted program or activity, and to all agreements the grant applicant makes to carry out the WIA Title I financially assisted program or activity. The Contractor understands that WFI and the United States have the right to seek judicial enforcement of the assurance. By signing below, the Applicant certifies and assures that it will fully comply with the applicable assurances outlined above. Name and Title of Authorized Representative Applicant Date NOTE: This assurance form MUST be signed and submitted with your proposal/application.