I. Company Information

Company Name: 
Street Address:   

City:                         State:        
County:                 Zip Code: 

Contact Person: 
E-Mail Address:    Title: 
Phone:           Fax: 
              xxx.xxx.xxxx - Format                                xxx.xxx.xxxx - Format
               

No. of  Employees:     Active:    On Layoff: 

Federal ID#:     SIC Code: 

Does the company have a labor union?  Yes   No

Are you located in the Westchester/Putnam economic development Zone?  Yes     No

How were you aware of this application?  Chamber of Commerce One Stop Partner Not Sure

Federal Workforce Investment Act (WIA) funding carries with it a requirement that newly hired trainees be referred through the local one stop system.  Are you willing to select new employees from among individuals matched by one stop centers in Westchester and Putnam Counties for WIA funded on-the-job training and classroom training opportunities in your company?  Yes  No

II. Purpose of Training Request

        New Location in Westchester/Putnam Startup Business Retention of Jobs Upgrading

III.  Nature of Business

Describe functions/Products/Services of the business and provide other relevent information about the company.



IV.  Statement of Needs

Discuss the business-related reasons for which this training request is being made.

V. Training to be Provided

Describe the training plan, including  purpose of training, type of training (on-the-job training (OJT), classroom training (CRT)).



VI.  Training Sub-Contracts

List all training providers with whom the employer will subcontract for the delivery of training (if applicable).  The One Stop Center also has a list of training providers currently under contract. 
Click Here to access that listing.

Include Contact person and phone number:







VII.  Employees to be Trained

VIII. Anticipated Outcomes

         Total number of individuals to be trained: 

                  New hires:         Current Employees: 

          Starting hourly wage for individuals to be trained:   $

No. of new employees to be hired as a result of incumbent worker training/upgrading: 
New jobs created due to business startup, expansion and/or relocation? 
Total number of employees to receive wage increases as a result of training? 
Total number of jobs retained? 
Will skills certified by the industry be obtained by completing training? Yes  No

IX.  Economic Development

Describe the economic impact that company expects to achieve through this project.  Have you received any financial assistance for economic or workforce development in the past 12 months? If so, please specify source and purpose of funding (e.g. New York State Department of Labor, Workforce Investment Board, Westchester County EEOC).



X. Budget Request

If you are requesting financial assistance for customized classroom training, please complete on-the-job training, please complete section B.

Customized classroom training is designed to meet the skill requirements of an employer and is often provided in partnership with an education or training provider.  Participating employers are required top contribute towards some of the total cost of a classroom training project.  The employer contribution may be in the form of the wage of trainees while they are engaged in the classroom training or the employer's share of other training costs.

On-the-job training (OJT) means training provided by an employer to an employee who is engaged in productive work.  Reimbursement of up to 50% of the wage rate can be p aid, to compensate the employer for the cost of providing the training and additional supervision related to the training.  OJT is limited in duration as appropriate to the occupation for which the participant is being trained, as well as the prior work experience of the participant.

*Note:  Individual trainees cannot simultaneously participate in subsidized OJT and classroom training.  In certain circumstances, these two activities may be provided to the same individual sequentially.