I



TRAC ASSOCIATES

WIOA ADULT/DISLOCATED PROGRAM

Program Assessment

| |

Name: __________________________________ Intake Date: ________________ Last First Middle

SS#: _______________ Phone: ______________ Email: ____________________

I. FINANCIAL

See Budget Form & Self-Sufficiency Calculator

Over Self-Sufficiency

Needs Financial Counseling

II. CAREER PLANNING/EMPLOYMENT GOALS

1. Clear occupational goal Yes, No

2. Occupation desired: __________________________________

3. List your qualifications for this occupation: _______________________________________

_________________________________________________________________________

_________________________________________________________________________

4. What is your reason for seeking vocational services at this time? __________________________________________________________________________________________________________________________________________________

_________________________________________________________________________

5. Summarize your most recent job search efforts (i.e., job titles you have applied for, job strategies, number of interviews you have completed, problems you have encountered).

__________________________________________________________________________________________________________________________________________________

_________________________________________________________________________

6. Summarize your immediate and long term career and/or personal plans:

__________________________________________________________________________________________________________________________________________________

_________________________________________________________________________

IF UNCERTAIN OF OCCUPATIONAL GOAL:

Choices Planner Workforce Explorer O*NET

COPS/CAPS/COPES CAI Other

TRAINING QUESTIONS

1. Why have you chosen this field? ______________________________________________

Have you done any research regarding this occupation? (Yes (No

What kind of research?______________________________________________________

2. Why do you feel you need training to achieve your educational goals? ________________

__________________________________________________________________________________________________________________________________________________

Are you eligible for FAFSA/financial aid? (Yes (No

3. Do you have any financial aid in default? (Yes (No If yes, please explain: _______________________________________________________________________

4. Are you enrolled in school or training now? (Yes (No

If yes, what program: __________________________ School: ______________________

5. Did you experience any learning difficulties in school? (Yes (No

6. Discuss how you will cover basic living needs while in school. If you have children requiring childcare, discuss the plans for covering this.

______________________________________________________________________

______________________________________________________________________

7. Completion of ITA packet

III. WORK HISTORY (see MIS Work History Form)

IV. TECHNOLOGY

What is your typing speed: >60wpm >40wpm >20wpm Cannot Type

|Computer Usage |

| |Highly Proficient |Proficient |Basic |Never Used |

|Word | | | | |

|Excel | | | | |

|PowerPoint | | | | |

|Outlook | | | | |

Do you have an email account? Yes No

Do you know how to search for a job on the internet? Yes No

V. EMPLOYMENT PREPARATION/WORK READINESS

1. Do you need assistance with the following:

Applications Resume Cover Letter Job Search Interviewing

Work Tools/Certification Other _______________________________

VI. EDUCATION

1. What is your highest grade level or degree completed? ________

2. If completed high school outside US or highest grade level is below 12:

|Academic Transcript | In file |

|Results |

|Compass, TABE or ASSET | |

|CASAS | |

|Recommendations if test results are below 12th grade level: See IEP |

|Declined to Test | |

If below 12th grade in English or Math, referred to __________________________________

EMPLOYMENT/TRAINING CONSIDERATIONS

1. Check any of the following issues that have created problems in finding or maintaining employment in the near past or present

|Did not complete high school |Limited English |Financial Issues/Debt |

|Immigration Status |Reading problems |Criminal History |

|Problems with Employer |Frequent relocation |Substance Abuse |

|Job Terminations – 2 or more |Suspended driver license |Physical Restriction |

|Relationship problems |Child support payments |Childcare problems |

|Housing issues or homeless |Limited/sporadic work history |Child with special needs |

|Lack of marketable job skills or skill |Car in disrepair or lack of transportation | |

|credentials | | |

If you have checked any of the above, please give details and describe how you are dealing with these issues now. Indicate whether you need assistance or resources:

______________________________________________________________________

______________________________________________________________________

2. What kind of transportation do you use? Car Bus Other

3. Are you working with any other agencies? Yes No If yes, which? ______________

RETURN TO WORK PRIORITY

❑ Services Not Required

Justification: _________________________________________________________________ ____________________________________________________________________________

____________________________________________________________________________

❑ Direct Job Placement (Transferable Skills)

Justification: _________________________________________________________________ ____________________________________________________________________________

____________________________________________________________________________

❑ Vocational Skills Training

Justification: _________________________________________________________________ ____________________________________________________________________________

____________________________________________________________________________

Comments:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

WIOA Adult/Dislocated Worker Program Requirements

The WIOA Adult/Dislocated Worker Program is a federally funded program, administered locally by the Workforce Development Council (WDC), and is designed to provide job placement, job retention and wage progression assistance. To be enrolled in this program, you must commit to the program goals of obtaining employment, remaining employed and advancing your standard of living by increasing your wages and/or benefits. It is an expectation of the program that you maintain consistent contact with the TRAC case manager throughout your program – including one year following the job placement phase. The information that is being collected here is crucial for developing a plan that will help you to succeed.

You may prefer, or it may be determined after assessment, that training is unnecessary or not an appropriate path. Assisted job search may prove more suitable for your circumstances.

You will be required to provide documentation verifying citizenship, residence, marital status, family size, income or other information required by this WIOA program, to determine eligibility. You will be required to sign a Release of Information to facilitate the exchange of specific information with other agencies and asked to complete an employment verification form following job placement.

Acceptance into the WIOA program is subject to verification of eligibility and assessment of appropriate qualifications. Providing necessary information and documents alone does not guarantee acceptance into the WIOA Adult or WIOA Dislocated Worker program. Any services, including funds for training, shall be provided only on the basis of available funding, reallocated each quarter.

I, ______________________________, understand the requirements and restrictions for registration in the WIOA program as outlined above. I wish to proceed and am willing to commit to these requirements. All of the information provided above is accurate to the best of my knowledge.

_______________ ___________________

Customer Initials WIA Case Manager Initials

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