Tennessee Career Center Local Workforce Investment Area 10 Individual Employment Plan (For Adult or Dislocated Workers Only)

Full Name: / SSN: Last four digits: / Registration Date: / FundingSource:

SECTION I: PREVIOUS EDUCATION & TRAINING

School or Training Provider: / Diploma / Degree / Certificate: / Dates Attended:

Career Readiness CertificateDate Administered:

Level Achieved:

Career ScopeDate Administered:

Top Work Group Recommendations (Areas with both interests and aptitude)
1.
2.
3.

TABE ScoresDate Administered:

READING / Scaled Score / GE / LANGUAGE / Scaled Score / GE / TOTAL MATH / Scaled Score / GE

OTHER ASSESSMENTS

1. / Date Administered:
2. / Date Administered:
3. / Date Administered:

SECTION II: EMPLOYMENT AND RELATED GOALS

Short Term Goal:

Long Term Goal:

SECTION III: WORK HISTORY

(Attach a copy of the WIA Registration (Intake) work history and additional work history form.)

SECTION IV: BARRIERS TO EMPLOYMENT

(Must check at least one)

Transportation
Childcare
Lacks H.S. Diploma / G.E.D.
Basic Skills deficient
Limited work history
Poor work history
Chemical Dependency
Lacks basic computer skills
Health / Medical
Skills do not match current job market
Not self-sufficient with current employment
Unemployed or underemployed
Criminal Background
Other ( please list all below )
1.
2.
3.
4.
5.

SECTION V: SKILLS & STRENGTHS

1.
2.
3.
4.

Section VI: ACTION STEPS AND SUPPORTIVE SERVICES

(Please Check All That Apply)

Core Services: / Person Responsible / Projected Completion Date
X / Complete Intake & Orientation to Services / Customer & Staff
Other:
Core and/or Intensive Services
Complete Assessments:
Career Scope
Work Keys
Review of Work History & Skills with Career Advisor
Other:
Individual Counseling & Career Planning
Complete Career Search Worksheet
Job Shadow
Occupational Interviews
Other:
Job Readiness
Complete Interview Stream
Attend Workshops listed below:
1.
2.
3.
. / Give Copy of Completed Resume to Career Advisor
Other:
Job Search Assistance
Register with TDOL & Workforce Development Job Service
Turn in Weekly Job Logs
Job Referrals
Other:
Pre-Vocational Services
Attend Study Skills For Academic Success
Complete FAFSA & Items on Training Checklist
Other:
1.
2.
Training Services: / Person Responsible / Projected Completion Date
Training Services
Training Provider / Program Studies:
Funding Source
On The Job Training
Employer:
Adult Education
Other:
1.
2.
3.
Supportive Services (must have barrier checked above):
1.
2.
3.
4.
5.
Referrals to Other Resources:
1.
2.
3.
Follow-Up
Complete Quarterly Follow-Up Contacts after Completion of Goals
Other:
1.
2.

I have met with Career Center staff to develop this plan and agree to complete all assigned activities.

I agree to maintain monthlycontact with Career Center staff.

If I am attending training, I agree to meet the academic and attendance requirements of the training provider and to provide Career Center staff with copies of my transcript or progress/attendance reports at the end of each term.

I agree to contact my Career advisor should issues arise that interfere with my training or job search.

I understand that all services available through the Career Center are contingent upon availability of funding and my meeting all eligibility requirements.

I understand that there will be a one year follow-up after I have completed program goals.

I agree to complete all follow-up surveys.

______

Customer SignatureStaff Signature

______

Date Date

1 | Page

Tennessee Career Center Local Workforce Investment Area 10 Individual Employment Plan (For Adult or Dislocated Workers Only)

INDIVIDUAL EMPLOYMENT PLAN AMENDMENTS

Date / Customer Signature / Staff Signature / IEP AMENDMENTS
Revised 5/15/12

1 | Page