599 training application




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Name:

     

SSN:

     




Instructions:

  • Complete and return this application to your One-Stop Center as soon as possible after you have been accepted into training. Proof of your acceptance into training and your attendance in at least 12 hours of classroom training or 12 credit hours per week are required. Necessary documentation must be attached for your application to be considered complete. (See Part III)

  • Answer all questions. Missing information will delay and/or impact the outcome of the application process.

  • Write your Social Security Number on each page of this application and on all attachments. Write only in the space provided, do not staple, or write outside the margins or on the back of the application. If additional space is needed, use an 8 ½” x 11” sheet of white paper.




PART I – Trainee Information (Use black or blue ink)

What was your most recent job title?


________________________________________________________

Dates of Employment:


From

     

to

     










What were your major job duties?



______________________________________________________________________________________________________________________________________________________________________________







Do you expect to be able to find another job in this same occupation?  YES  NO


If “NO”, why not?


___________________________________________________________________

If you had other employment in the past 3 years, list dates of employment, your job titles and briefly describe your job duties.



_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Was your last job;


 Full time  Part Time  Days  Evenings  Nights  Weekends


(check all that apply)

 Other:

____________________________________________________________

During what hours and days are you currently available for work?

________________________________________________________________________________________

What type of work are you currently seeking?



_________________________________________________

NOTE: Unless and until you receive written notice of approval under Section 599, you must be ready, willing and able to work full-time as well as actively seeking work in order to maintain your unemployment insurance eligibility. You are required to keep a written record of your job search efforts.

If you do not receive Section 599 approval,


Are you willing to quit school for full-time work?  YES  NO


If no, why not?


_________________________________________________________________________

Can you work full-time around your school schedule?  YES  NO


If no, explain?


_________________________________________________________________________




Name:

     

SSN:

     

List any previous training/college programs that you have completed.



School/City/State

Training Course/Major

Date Completed

     

     

     

     

     

     

     

     

     




PART II – Training Information

Name of School or Training Facility where currently enrolled:

________________________________________________________________________________________

Address:


______________________________________________________________________________

City


__________________________________

State


_______________

ZIP


__________

Contact Person:

___________________________________________

Phone:

     

Training Program Title:


__________________________________________________________________

Beginning date of training:


     

Training ending date (Graduation):


     







month/day/year




month/day/year




Job skills to be learned:


__________________________________________________________________

Degree or Certificate to be earned:


__________________________________________________________

In what specific occupation do you intend to work after the completion of your current training?


________________________________________________________________________________________

After the completion of the above training program, will you require any additional training before being qualified to work in this specific occupation?  YES  NO


Is your training being paid for by WIA or Trade Act funding?  YES  NO


If “YES”, Counselor Name:


_________________________________

Phone:


     

Indicate if you have previously taken this training:  YES  NO


If yes, indicate when, where and why you need to take it again:


________________________________________________________________________________________________________________________________________________________________________________

For the next six months, indicate the dates of any breaks in training (vacation, spring break, etc.) that will exceed five weeks in length.

________________________________________________________________________________________________________________________________________________________________________________




Name:

     

SSN:

     




PART III – DOCUMENTATION OF TRAINING ACCEPTANCE AND PARTICIPATION

Please describe the documents you are attaching to show training acceptance date, training start date, and training hours. (Examples: Letter of acceptance, invoice from training provider, training schedule)

  • Document showing training acceptance date:

     




  • Document showing training start date and training end date:

     




  • Document showing 12 credit hours or a minimum of 12 classroom hours per week:

     




Indicate total credit hours or total hours per week of classroom instruction:

  







The following documentation is only required if you are already attending training.





Not Required

Describe the Document Attached (Example: Most Recent Report Card)

Transcript/Grades




____________________________________________________


PART IV – Certification

1. I have carefully read and reviewed my application for possible mistakes or omissions and understand that an incomplete application may result in a disapproval of training.

2. I understand that I must remain ready, willing and able to seek and accept work until I am approved for the 599 program.

3. If approved for the 599 Program, I will advise the UI Special Programs Unit of any changes in my courses or training schedule. I will submit a copy of the revised schedule as soon as it becomes available. I will submit a copy of my grades at the end of each grading period.

4. If approved for the 599 Program, I understand that the school/training institution will have to provide to the Department of Labor evidence of my satisfactory progress and attendance periodically, and that it is my responsibility to see that this is done.

5. I understand the law provides severe penalties for willful false statements used to obtain UI benefits.


IMPORTANT NOTICE

Acceptance into approved training under Section 599 of the Unemployment Insurance Law does NOT guarantee you will receive additional unemployment benefits. You should not enroll in training expected to extend beyond your normal 26 week entitlement to Unemployment Insurance unless you can afford to complete the training without receiving additional benefits. If you do become eligible for additional benefits, the maximum you may receive is 26 weeks.





Signature:





Date:





Phone:


( ) -

Local Office:











OS44 (07-08)

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