State of Utah PLEASE RETURN APPLICATIONS TO: Utah Department of Workforce Services
Attn: Workforce Development & Information Division
140 E 300 S Salt Lake City, Utah 84111
Rev. 08/09/07 Department of Workforce Services INCUMBENT WORKER TRAINING APPLICATIONI. BACKGROUND INFORMATION Applicant (Company Name): FEIN Number Unemployment Insurance Number Site Street Address City County State Zip Type of Business or Industry Union/Local/Contact Person/Phone Number (if applicable) Parent Company Names(s) SIC Code Parent Company Address(es) City State/County Zip Phone # Primary Company Contact(s) Title Phone Number FAX Number e-mail Address II. PROJECT OUTCOMES Total number of people to be trained: ___________________
Identify the number of training credentials/certifications planned for this proposal: Type Projected Number
Apprenticeship 00/font> _____________________________
Associate Degree/Other College Degree 00/font> _____________________________
Certificate of Completion 00/font> _____________________________
Journey Level Upgrade 00/font> _____________________________
Other Industry Recognized Certification 00/font> _____________________________
(Specify:) ____________________________________________________________
III. EMPLOYMENT AND WAGES Current total number of employees _____________________Have you had a Reduction in Force within
the past 3 months? Yes 00/font> No 00/font> If yes, explain: _______________________ ________________________________________________________________________________________________
Average hourly wages of employees (without fringe benefits)
Professional/Managerial $ ________________________________
Skilled Trades $ ________________________________
Semi-skilled/Production/Administrative $ ________________________________
Total annual payroll for business location $ ________________________________
Provide, as an attachment, most current audited financial statement. Please attach a project description which includes the following: The company and product or services performed. The impact to the industry sector, the community and/or economic area. Current investment in training of incumbent workers. The current economic conditions that may support the need for training. The reasons the training is needed. How the project will be implemented and approximate start and end date of training. How the training will benefit the company, improve the productivity, competitiveness and/or quality of products and services. Business outcomes anticipated from this award and how they will be measured How the training will benefit the employees including career paths and hourly wage increases for employees who successfully complete the training program.Page 2
V. BUDGET DETAILS Please complete the budget summary. Also provide a budget narrative that explains how the costs were determined to include in-kind and/or cash matches. Please note: the budget should only include information for the project for which the funding is being requested. (Federal funding cannot be used as part of matching funds) PROJECT BUDGET SUMMARY Training FundsRequested
Internal Use OnlyAmount Awarded
1. Personnel a. Salaries & Wages $ $ b. Fringe Benefits c. Consultant/Contract Services d. Tuition Sub Total 2. Non-Personnel a. Rental, Lease orPurchases of Equipment
$ $ b. Supplies for Training c. Travel d. Books/Lab Fees e. Other Sub Total Total 3. Current company annual training budget $ 4. Other training funds received Source Date Received Amt of Award Source Date Received Amt of Award I certify the applicant will provide the required 50% in-kind/or cash match. Yes 00/font> No 00/font> If awarded, I agree to list job openings with DWS/jobs.utah.gov. Yes 00/font> No 00/font> I certify having not received a federal debarment notice. Yes 00/font> No 00/font> If awarded, I certify that the Incumbent Worker funds will not be used to displace current employees Yes 00/font> No 00/font> NOTE OF CONFIDENTIALITY OF INFORMATIONTo the extent feasible and permissible
by law, the Utah Department of Workforce Services (DWS) will honor an
applicant00 request that confidential information submitted to DWS
will remain confidential. DWS will treat the information confidential
only if: (i) the information is in fact protected confidential information
such as trade secrets or privileged or confidential commercial or financial
information, (ii) the information is specifically marked and identified
as confidential by the applicant, (iii) the information is segregated
and placed in a separate appendix to the application, and (iv) no disclosure
of the information is required by law or judicial order. If the
application results in a grant or loan, the honoring of the confidentiality
of identified data shall not limit DWS00right to disclose the details
and results of the economic development project to the public.
AWARD INFORMATION
Companies approved for the Incumbent
Worker Training Program (IWTP) may not be funded for the full amount
requested. Department of Workforce Services reserves the right
to distribute funds relative to the total budget available and the number
of approved companies00state wide.
MANAGEMENT CERTIFICATION
I herby certify that I have read the foregoing project file and that the information contained herein is true and accurate to the best of my knowledge and belief. Furthermore, to the best of my knowledge and belief, our company and/or organization does not have any outstanding liabilities with the State of Utah, including but not limited to the Department of Workforce Services, Unemployment Insurance Contribution Division, nor are we currently involved in any labor disputes.
APPLICANT AUTHORIZATION
Name Title (CEO or highest ranking applicant official) Date Equal Opportunity Employer ProgramAuxiliary aids and services are available upon request to individuals with disabilities by calling (801) 526-9240. Individuals with speech and/or hearing impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.
