Training Benefits

• Name: Social Security number:

• Name: Social Security number:

• Mailing address, including city, state and ZIP code:

• Mailing address, including city, state and ZIP code:

• Mailing address, including city, state and ZIP code:

• Mailing address, including city, state and ZIP code:

• Physical address (if different than mailing address): · if it applies

• Physical address (if different than mailing address): · if it applies

• Physical address (if different than mailing address): · if it applies

• Physical address (if different than mailing address): · if it applies

• Primary daytime phone number:

• Email address (optional): · optional

• Have you received Training Benefits in the last five years? Yes No

  Yes · No

• Were you honorably discharged from the military or Washington State National Guard in the last 12 months? Yes No

  Yes · No

• Are you currently in the Washington State National Guard? Yes No

  Yes · No

• Do you have a disability, illness or injury that prevents you from working in your previous occupation? Yes No

  Yes · No

• If yes, please explain and include medical documents: · if it applies

• In the past three years, what has been your main occupation?

• What is your standard occupational classification code (SOC), or best match for your main occupation based on your employment in the past three years?

• a.

  In decline · Balanced · In demand

• c. If your main occupation is in demand or balanced, provide written information explaining why you need training to find suitable employment. · if it applies

• Are you willing to commute for your main occupation? Yes No

  Yes · No

• b. List the county or counties where you would be willing to commute for your main occupation: · if it applies

• Are you willing to move for your main occupation? Yes No

  Yes · No

• b. List the county or counties beyond where you live that you would be willing to move for your main occupation: · if it applies

• c. If you are not willing to move, please explain why: · if it applies

• What is your highest level of education?

• Do you have a degree or certificate? Yes No

  Yes · No

• Name of school: · if it applies

• Name of training program or major: · if it applies

• Type of degree or certificate earned: · if it applies

• Date degree or certificate was earned: · if it applies

• Did you receive a Worker Adjustment and Retraining Notice (WARN)? Yes No

  Yes · No

• Name of employer that issued the WARN: · if it applies

• Date notice was issued: · if it applies

• What is the exact name of your training program:

• a. List the school name and city where the campus is located:

• a. List the school name and city where the campus is located:

• b.

  Yes · No

• What date does your training start (mm/dd/yy): / /

• What date does your training end (mm/dd/yy): / /

• Does your school consider your training to be full time? Yes No

  Yes · No

• This training will lead to a (choose one): Certificate Two-year degree Two-year transfer degree Four-year degree Higher than four-year degree Other:

  Certificate · Two-year degree · Two-year transfer degree · Four-year degree · Higher than four-year degree · Other:

• Four-year degree Higher than four-year degree Other: · if it applies

• Are the jobs you listed above in demand where you live, according to the Workforce Development Council list at esd.wa.gov/labormarketinfo/learn-about-an-occupation or to careeronestop.org/JobSearch/Plan/whats-in-demand.aspx if you live outside Washington state?

  Yes · No

• For the new occupation, are you willing to commute outside of the county where you now live? Yes No

  Yes · No

• a. If yes, list the county or counties where you are willing to commute: · if it applies

• For the new occupation, are you willing to move outside of the county where you now live? Yes No

  Yes · No

• a. If yes, list the counties where you are willing to move: · if it applies

• Have you been approved for a special grant or program, such as Workforce Innovation and Opportunity Act, Dislocated Worker or Trade Adjustment Assistance?

  Yes · No

• Name of grant/program: · if it applies

• Counselor/advisor name: · if it applies

• Counselor/advisor phone number: · if it applies

• Counselor/advisor email address: · if it applies

• a. Training?

• b. Living expenses?

• If you are turning in this application past any of the deadlines, explain why it is late: · if it applies

• What are your job search and employment plans if you are not approved for Training Benefits or Commissioner Approved training?

• a. Attending training? Yes No

  Yes · No

• b. Registered for training? Yes No

  Yes · No

• How many credits are you or will you be taking?

• How much have you spent on tuition, books, fees and expenses for this training?

• Online

• In person

• Correspondence

• a. If you attend online, are you required to be available for class at a specific time? Yes No · if it applies

  Yes · No

• b. If yes, what days and times? · if it applies

• How many hours do you or will you spend studying, both during and outside of class each week?

• Have you been and are you now looking for full time work? Yes No

  Yes · No

• a. If no, when did you stop looking for full time work? · if it applies

• Have you limited your job search in any way, such as the hours you are available for work, working only until training starts, or the type of work you are willing to do?

  Yes · No

• a. If yes, please explain: · if it applies

• Days

• Swing

• Graveyard

• How many hours per day and days per week can you work? hours per day

• days per week

• Sun

• Mon

• Tue

• Wed

• Thu

• Fri

• Sat

• Are your classes available other hours? Yes No

  Yes · No

• If we do not approve Training Benefits or allow Commissioner Approved Training and you are offered work that conflicts with your class schedule, will you drop classes to accept it?

  Yes · No

• a. If yes, will you still drop out of training if the school will not give you a refund? Yes No · if it applies

  Yes · No

• b. If no, explain: · if it applies

• If we do not give you a job search waiver, what would you do if you were offered employment that requires you to work at the same time that you normally go to your classes?

• In the past, have you worked full time while attending school? Yes No

  Yes · No

• How did you manage working full time while attending school? · if it applies

• What will you tell employers about your availability for work when you apply for or are offered a job?

• Signature: Date:

• Signature: Date:

• Phone:

• Is the applicant’s training full time? Yes No · if it applies

  Yes · No

• Progress reports will be issued to the student every six weeks while in training. · if it applies

  Yes · No

• Is the applicant taking English as a Second Language or English Language Learner courses? Yes No · if it applies

  Yes · No

• Is the applicant taking basic education classes? Yes No · if it applies

  Yes · No

• What date did the applicant enroll or get on a waiting list to start training? (mm/dd/yy) / / · if it applies

• What date is the applicant’s first day of training? (mm/dd/yy) / / · if it applies

• What date will the applicant complete their program? (mm/dd/yy) / / · if it applies

• I have reviewed Section 2 (Training program information) and I certify the information I provided is true to the best of my knowledge. · if it applies

• Name: Title/Position: · if it applies

• Name: Title/Position: · if it applies

• Phone: Email: · if it applies

• Phone: Email: · if it applies

• Signature: Date: · if it applies

• Signature: Date: · if it applies

• Print Name: Date received: · optional · if it applies

• Print Name: Date received: · optional · if it applies

• Signature: Email: · optional · if it applies

• Signature: Email: · optional · if it applies

Job(s) you will qualify for when you finish training:: answered for each person (• Job title and SOC Code:, • Job title and SOC Code:).

Record your work history for the past three years, starting with your most recent employer.: answered for each person (Last employer: Job title:, Last employer: Job title:, Mailing address:, City: State: ZIP:, City: State: ZIP:, City: State: ZIP:, Dates worked in this position: Job location:, Dates worked in this position: Job location:, Dates worked in this position: Job location:, Description of tasks and responsibilities).

What is your class schedule this quarter or term?: answered for each person (Class name Course number Credit hours Class times Class days, Class name Course number Credit hours Class times Class days, Class name Course number Credit hours Class times Class days, Class name Course number Credit hours Class times Class days, Class name Course number Credit hours Class times Class days).

• While you wait, start training as planned, remain available for work, continue job search and file weekly claims. Tell ESD if you delay, withdraw or change the application.
• After approval, follow the training plan and make satisfactory progress. Complete the progress forms ESD sends.
• Ask ESD before changing your approved plan. Unapproved changes may lead to repayment or a return to job search.
• You may ask for an interview by phone or in person before the eligibility decision and have someone, including an attorney, help you.
• ESD says it may take up to 12 weeks to give a decision.
• The provider is asked to certify progress and enrollment on reports issued every six weeks.
• Training Benefits stop when training ends or available benefits run out. Current law generally limits payment to two years beyond the regular claim benefit year, with listed extended-benefit exceptions.
• ESD may approve or deny Training Benefits. If denied, ESD uses the packet to consider CAT, which waives job search without adding benefit weeks.
• Your approval letter tells you the benefit weeks and amount per week.
• Benefits for low-wage, disability and military categories are subject to available funds. ESD must confirm availability.

• Keep searching for work and filing weekly claims until ESD approves a training waiver.
• The packet also lets ESD consider Commissioner-Approved Training if you do not qualify for Training Benefits. CAT does not add benefit weeks.
• For changes to an approved plan, use the separate Request to modify training plan form. A finished plan followed by a new plan needs a new application.
• Do not use the claim-opening date as a substitute for an ESD notice without checking your deadline. The page and current statute use different starting dates.

• Public applications are offered. Personal claim deadlines still apply. No calendar-wide closing date is stated.
• Some details here could not be confirmed. Check with Washington Employment Security Department before you apply.