Customized Training/OJT Business Application

General Business Information

Business Name

Address

City

State

E-mail

Phone

Fax

Contact Person(s)

Business Website URL

FEIN#

NAICS#

Type of Business/Main Product:

Training Location

(If different from business address)

Is the business/ training location accessible by public transportation?

Yes

No

Bus Lines

MD. SDAT Status:

Good

Not Good

Forfeited

Number of years in operation:

How long at this location:

City Enterprise Zone?

Yes

No

Minority/Woman Ownership?

Yes

No

Workers’ Compensation Insurance Information:

Name

Policy Number

Coverage Dates

Does your company have written personnel policies and grievance procedures?

Yes

No

Does your company conduct employee performance reviews?

Yes

No

How often?

Is the occupation in which training is being offered subject to a collective bargaining agreement?

Yes

No

Name of Union:

Local No:

Union Representative Name:

Title:

Phone #

Will this training replace or displace current or laid-off workers?

Yes

No

Most recent lay-off date?

If the business is a new acquisition, was the previous workforce laid-off or displaced as a result of the acquisition?

Yes

No

If yes, what efforts were made to rehire those employees? Indicate any challenges that prevented their rehire?

Total Number of Employees:

Ratio of trainees requested to employees in the same position (%):

Standard Work Days

M

T

W

Th

F

Sa

Su

How often are employees in the same position paid?

Weekly

Biweekly

Monthly

Other

What is the pay day for employees in this position? - None -MTWThF

Check benefits available to new employees. Check below all that apply

Medical Insurance

Life Insurance

Holidays (Paid)

Sick Leave

Vacation (Paid)

Retirement Benefits

Other

Training Description

Training Job Title:

DOT/SOC:

SVP:

Requested Training Start Date

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Year Year2024202520262027

Requested Training End Date

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Year Year2024202520262027

Starting Wage

Brief Description of Job:

Attach job description with position requirements

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Reason Training is required

Business Start-Up

Business Relocation

Business Expansion

Recruitment Challenges

Other

If Other, please explain

Proposed Training Model (check all that apply)

Customized Training or OJT provided by the employer

Customized Training delivered by a training vendor

Combination of models

Other

If Other, please explain

Training Supervisor Name

E-mail Address

Other Staff who will provide training:

E-mail Address

Training Vendor (if applicable) :

Contact Name

Phone

E-mail Address

Training Objectives

List all training objectives and modules that will be included in this training program. Also, identify the number of weeks required for each.

I certify that all of the information provided on this application is accurate to the best of my knowledge. I understand that all applications are subject to approval and available funding. Training must not start before official written approval from MOE *

I agree

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