/ ARMED FORCES MEMBER SUBSIDIZED TRAINING AND EMPLOYMENT GRANT PROGRAM AGREEMENT
(Rev.05/26/2015)
WBD Agreement No. / WPM-001 / EWIB / NC WIB / NW WIB / SC WIB / SW WIB
Parties To Agreement / WBD Name:
Address:
Street / City / State / Zip
WDB’s STEP UP Rep:
Name / Phone Number
Email:
Employer’s Legal Name: / NAICS
DBA (if applicable):
Employer’s STEP UP Rep:
Name / Phone Number
Email:
Terms and Conditions Of Agreement / Agreement Start Date: / Agreement End Date:
The total dollar amount of this agreement is not to exceed: / $
These funds shall be used to subsidize the wages of:
The parties hereto agree that the Employer shall employ and provide all training services for the named employee. In consideration for such services, the Employer shall receive an amount not to exceed the total amount shown above. This amount shall be paid pursuant to the terms and conditions of this Agreement. Employer’s training plan and certification of eligibility of both employer and employee for these Step-Up program funds are required.
STEP UP EMPLOYER INFORMATION
Employer’s IRS ID No. or FEIN No: / Employer’s State Unemployment Tax No.:
Employer Address:
Street / City / State / Zip
Remittance address if different:
Street / City / State / Zip
Would you (Employer) have hired this EMPLOYEE without STEP UP incentives? / Yes / No
EMPLOYER CERTIFICATION
Employer named in this Agreement certifies that it:
  • is a business with operations in Connecticut;
/ Yes / No
  • has been registered to conduct business for not less than twelve months;
/ Yes / No
  • is in good standing with the payment of all state and local taxes.
/ Yes / No
EMPLOYER CONDITIONS and ESTIMATION OF INCENTIVES:
  • Wage subsidy reimbursement for new hire for 180 days is capped at an hourly rate of $20.00 per hour, excluding benefits.
  • STEP UP employees are only eligible for wage reimbursement from the funding for the STEP UP program for up to 40 hours per week in accordance with the terms of the program. Any hours worked over 40 hours per week shall be at the Employer’s expense according to wage and hour regulations. After successful completion of the six-month training period, the Employer shall make all good faith efforts to retain the named employee as a full-time employee.
  • The employer’s STEP UP Representative agrees to provide wage and hour, and worker status information for the STEP UP employee on a monthly basis to the WDB’s STEP UP Representative for the purposes of wage reimbursement and program evaluation.
  • The STEP UP employer cited in this Agreement is required as a condition of this Agreement to contact or be contacted by the WDB Regional Coordinator at the expiration of the term of this Agreement and provide information as to the status of the hire made under this contract: (1) whether the hire is still employed or is no longer employed and (2) whether or not any such hire was promoted and given a raise in hourly wage after this Agreement ended.
CONTINUED ON NEXT PAGE
Employer’s Legal Name: / WDB Agreement Number:
EMPLOYER CONDITIONS and ESTIMATION OF INCENTIVES, continued:
STEP UP Employer wage reimbursement under this Agreement shall be in accordance with the following estimation (calendar days):
Days 1 -30 @ 100% = / $ / Days 91 -150 @ 50% = / $
Days 31 -90 @ 75% = / $ / Days 151 -180 @ 25% = / $
STEP UP EMPLOYEE INFORMATION:
Employee Name:
Address:
Street / City / State / Zip
Telephone Number: / Email:
This employee shall be hired and trained as a(n):
This employee’s start date shall be: / The number of hours per week that the employee shall work is:
The starting hourly wage is: / $
MILITARY SERVICE ELIGIBILITY:
  • employee was a member of the Armed Forces;and
/ Yes / No
  • employee was honorably discharged after not less than 90 days of service, unless separated from service earlier because of a documented service-connected disability rated by the United States Department of Veterans Affairs.
/ Yes / No
Connecticut Department of Labor Veterans’ Representative:
I certify that the Employee named in this Agreement meets the military service eligibility criteria for the STEP UP program.
Signature of CTDOL Veterans’ Representative / Date
SIGNATURES AND APPROVALS:
The parties to this Agreement hereby certify by their signatures that the respective information each has provided is true to the best of their knowledge and belief and that they agree to the terms and conditions stated herein and will comply with their respective duties and responsibilities under this Agreement.
STEP UP Employer:
Signature of Employer’s Authorized Officer / Title / Date
I certify that the above-named authorized officer held said title at the time he/she signed this Agreement on behalf of the Employer and I also certify as keeper of the records of this Employer that this Agreement was duly signed on behalf of said Employer by authority of its governing body and within the scope of the Employer’s organizational powers.
Signature of Employer’s Certifying Officer / Title / Date
Approval by WDB:
Signature / Title / Date
Approval by The Workplace, Inc:
Signature / Title / Date