On the Job (New Employee) Training Form

Company name

FEIN:

Address

Which county?

Richland County

Crawford County

Contact first Name

Contact last name

Under what other names, if any, do you do business? Please list names and locations below:

How long have you been in this area?

Is the business being sold, closed, relocated, or merging with another company?

Yes

No

What is your chief product or service?

What is your NAICS code?

If you don't know, search for NAICS codes at: www.census.gov/cgi-bin/epcd/srchnaics02defs

Number of part-time employees:

Number of full-time employees:

How many new hires do you anticipate making in the next two (2) years?

What job titles or job descriptions will need to be filled?

Attach job descriptions, if available.

Do you use a staffing agency?

Yes

No

If so, which one? Please describe the relationship:

Who will receive the OJT payments? (Include name, address, and contact info)

Are jobs expected to last a year or more in the normal course of business?

Yes

No

Do you have sufficient equipment, materials, and supervisory time and expertise to provide necessary training?

Yes

No

What licenses or entry certifications do your workers need? (An attached job description may suffice.)

Is the pay of any job based upon commissions, tips, piecework, or incentives?

Yes

No

Is there a base wage that commisions, tips, piecework, or incentives are added to?

Yes

No

If yes to either of the above, what entry earnings may be expected?

What fringe benefits are provided to regular employees and when are they made available?

Do you have a payroll system that records all paychecks and amounts?

Yes

No

Can you verify wage payments quickly onsite?

Yes

No

If no to either, how will wages be verified for OJT payments?

What is your Workers' Compensation carrier (or equivalent system)?

Carrier number:

Will OJT trainees be covered?

Yes

No

Are any of the jobs considered for an OJT to be filled by "independent contractors? or individuals not employed by your firm during the entire training period?

Yes

No

Are any of the jobs covered by a collective bargaining agreement?

Yes

No

If yes, obtain and attach a "concurrence letter" from the union(s):

What are your turnover patterns and causes?

Could we do anything to help lower your turnover? If yes, please describe:

How many employees, if any, are currently on layoff, and what are their job classifications?

Are there any outstanding wage and hour; health and safety; or discrimination complaints or adverse decisions on your firm?

Yes

No

If yes, within how many years?

Has your company relocated from another labor market in the U.S. within the last 120 days, leaving any workers behind?

Yes

No

If yes, please list facility locations where you are seeking or receiving WIA or trade assistance for job losses.

If yes, please list facility locations where you have filed WARN notices in the past six (6) months.

If yes, please provide the date that production of goods or services began at the new location:

Over the last two (2) years, what percentage of previous OJT trainees have completed training and been retained by your firm?

Number of trained employees retained:

Number of OJTs: