Workforce Investment Act (WIA) Orientation/ Delaware County – Area 7

A One Stop Services Provider and Ohio Means Jobs Affiliate

Customer Completion Verification

Name PRINT: ______Last 4 digits of SSN: ______

Contact Information:

Address/City/Zip: ______

Home Phone: (______) ______E mail: ______

Cell: ( ) ______Cell Provider: ______May we text you? ______

Orientation Key Points:

I attended WIA Orientation on: ______and received a copy of this form. I can request a signed copy at any time. I understand: (please initial all that applies to you)

______Workforce Investment Act services are NOT entitlement services: some services require documentation of financial, employment status eligibility for me and/or household. WIA enrolled services are not guaranteed to me and are based on my eligibility, county funds availability, and suitability factors.

______I understand that the Orientation is not the WIA Application. After completion of orientation, I may choose to schedule a WIA application appointment by calling 740/548-6665 or walk-in in the One Stop Center. If I do not show for a scheduled appointment, it is my responsibility to re-schedule. I must submit required documents prior to funding eligibility determination. (Applications can “pend” for maximum 30 days to submit documents).

______In addition to funding eligibility, I must also demonstrate “suitability”. Area 7 Workforce Suitability Policy can be reviewed at the Area 7 website: ALL program policies can also be found at this website. “Suitability” determination requires personal assessmentsof math and language skills, computer skills, Work Keys (WIN) assessments, and other assessments and/or personal information that is relevant to my services access. If my request is for Training services, the school/program I wish to attend must meet additional criteria of Eligible Training Provider and Program, and I can obtain this information at

Fees incurred or student loans received/applied to costs before WIA enrollment are not eligible for WIA funds. Individuals can not be reimbursed for any forms of payments.

______I have received a copy of the WIA Complaint Procedure. I understand that there are three different categories of complaint procedures and are identified on the form: One for Discrimination (EEO) and One for Program services and One for Fraud, Abuse, and Criminal Activity. Discrimination complaints are handled through Civil Rights Center. Contact the EO Officer listed on the hand-out.

______WIA Intensive and Training services require that I show that I have been conducting a serious job search AND complete CORE service (s) and will require further assessments as indicated by my request and/or personal situation. CORE service(s) are available to me (at no cost) through the two Delaware One Stop Centers:

1) CCRC at 4565 Columbus Pike (Delaware Area Career Center South) or

2) Employment Resource Center located at 140 N. Sandusky Street, second floor.

______I understand that if I have “‘enrolled” with a WIA program in another county, I can continue to use Delaware’s One Stop Centers and CORE services, but I will not be able to enroll in WIA services in Delaware County without agreement of both counties.

Customer Signature: ______Rjl 08/10

Verification Number: ______