Southwestern Area Local Workforce Development Board

Southwestern Area Local Workforce Development Board

PARTICIPANT AGREEMENT FORM

I, ______understand that as a requirement of my participation in the Workforce Innovation & Opportunity Act (WIOA) training program, I MUST comply with the following: (if applicable)

_____ General: I understand that if I’m eligible for WIOA training services, the training must be in an occupation in demand in accordance with the SAWDB policy and through an approved training provider in NM.

If the occupation is not in demand, a pre-hire letter from an employer to meet SAWDB policy is required

_____ General: I certify that I have reviewed the information contained on the VOSS application for services and certify that the information is true and correct to the best of my knowledge.

_____ General: I must inform the NMWFC staff and/or case manager of any changes to my address, phone number(s), and my alternate contacts information, if it changes.

_____ General: I have been provided with an orientation regarding services available to me under the WIOA

program and I fully understand my responsibilities as a participant

_____ General: I have been informed of the Civil Rights and Grievance Procedures, Drug-Free Workplace requirements, Follow-ups, and other services available to me. Also, I was provided with an information sheet regarding these procedures, services and requirements.

_____ General: I cooperated with my case manager and provided the information needed for the completion of the electronic Individual Employment/Training Development Plan (IEP) in VOSS; the information provided is true and correct to the best of my knowledge; I understand the plan and agree to achieve my employment/training goal(s).

_____ General: Nepotism Information/Conflict of Interest Disclosure: (please circle) YES NO

I am aware that it is unethical for me to receive services from an immediate relative working for the NMWFC

If yes, please provide the following information for approval in accordance with the SAWDB Policy.

Name of Relative: / Office Location:

_____ ITA: Attendance Policy: I understand that if I do not report to classes one week following the official

start date of training, no payment will be made to the training institution and I will be responsible for all

fees incurred. If I withdraw within the allowable time, the NMWCC will coordinate with the training

institution to adjust any authorized WIOA funds per institution’s refund policy

______ITA: GPA Requirements: I understand that I need to maintain a grade point average (GPA) of 2.0

(“C”) cumulative or better to continue receiving WIOA services.

_____ ITA: Grades/Financial Aid: I must provide my case manager with copies of my grades each semester.

If I failed to do so, I hereby give the training institution permission to release and/or discuss any information related to my school account (financial aid, grades and/or transcripts) with my WIOA case manager at the New Mexico Workforce Connection Center.

_____ ITA: Completion/Diploma: I agree to provide copies of all certificates, diplomas, licenses, etc., obtained as a result of my training funded by the Workforce Innovation & Opportunity Act (WIOA). If I fail to do so, I hereby give the training institution permission to release any and all documents which will verify my completion of the training provided under WIOA.

_____ ITA Contract: Signatures: I understand that I cannot start training until contracts have all signatures and dates completed.

“An Equal Opportunity Program”

_____ Supportive Services Policy: I understand that if I’m eligible for supportive services (transportation,

child care, temporary shelter, etc.), my responsibility will be to turn in time and attendance reports to the

NMWFC on a timely basis (biweekly) and pick up checks during the designated dates only.

Payment for untimely attendance reports will not be guaranteed.

_____ OJT: I understand that as an On-the-Job Training (OJT) Participant, I must report to work as schedule

and follow my training plan as well as the employer’s rules, policies and procedures. I must

contact the WFC and/or my case manager if any issues arise while in training before making any

decisions that could affect my training.

_____ General: I hereby give permission to my past and/or present employer(s) to release information

regarding my employment and earning to the NMWCC.

List at least two people who will always know your whereabouts.

______

Name Address Phone

______

Name Address Phone

I understand that my participation will help the New Mexico Workforce Connection Center staff to better serve my needs and that the information I provide will be kept strictly confidential. By signing below, I agree to all the WIOA requirements of participation as noted above.

______

Participant Signature Date

______

NMWCC WIOA Staff Signature Date

This is a Southwestern Area Workforce Development Board Form and it cannot be changed/ revised without prior approval.

Revised: August 2015

“An Equal Opportunity Program”