Eligibility Pre-screening

Many individuals that are seeking employment or training in a high demand occupation may qualify as eligible for assistance from Tri-Parish Works Business and Career Solutions Centers and the Workforce Development Board. Your answers to these questions will help us determine if you meet initial criteria for certain funding assistance, that may include, tuition, supplies, tools, fees, stipends, child care, or transportation, etc.

Please complete all questions with accurate information so that we may assess your situation and provide the most assistance. If you are likely to be eligible based on your answers, you will be contacted to provide additional documentation to verify your eligibility.

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* 1. Please provide the following contact information

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* 2. Which of our Training Provider are you attending or are planning to attend? Select One

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* 3. What is the name of the training, degree or certificate program.

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* 4. The purpose of WIOA funding is to help you overcome barriers that might keep you from completing training.  What type of financial assistance are you in most need of:

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* 5. What is your current employment situation?

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* 6. Please answer the following questions to assist us in determining your eligibility as a "dislocated worker" Please answer each question carefully and accurately.

  Yes No
Are you a recently separated veteran?
Are you the surviving spouse of a veteran who is eligible for VA benefits?
Are you receiving or have you exhausted unemployment benefits?
Were you laid off in the last 7 years and now making less wages than before?
Did your previous employer close or go out of business?
Did you work less than 20 hours a week in your last job?
Was your last employer a temporary employment agency?
Are you not likely to return to your previous occupation with the skills you currently have?
Were you self-employed, but the economy or a natural disaster has put you out of business?
Have you been dependent on the income of another family member and are no longer supported by that income; and are unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment?
Would you estimate that, since December 2007, you have been unemployed for 27 weeks or more in total? Not required to be 27 consecutive weeks.

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* 7. If you indicated that you are a recently separated veteran, please indicate your date of separation.

Date of separation:

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* 8. Please complete the following for additional eligibility consideration:

  Yes No
Do you or someone in your household receive Food Stamps (SNAP):
Do you or someone in your household receive Welfare Assistance (TANF):

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* 9. Please complete the following for additional eligibility consideration:

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* 10. I certify that the information provided is true and accurate to the best of my knowledge. Please enter today's date

Today's date:
Thank you for completing the pre-eligibility application. If you are determined eligible you will be contacted by your local Business and Career Solutions Center to complete your application and provide the following documentation:
> Valid Driver's License or State ID
> Social Security Card
> Employment history, including dates of employment
> If a male over the age of 18, Selective Service verification
> If a veteran, DD-214
> Additional documentation to verify eligibility will also be requested

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* 11. Please register or update your information in HiRE at www.Laworks.net. The more updated and complete this information is, the more quickly we can process your eligibility determination. Even if you are not eligible, registering in HiRE will give you a head start in finding that future career that you have always wanted.

Please tell us about your career interests to help us better understand your needs. Also, feel free to let us know if you have any questions or concerns that you would like to have answered by a staff member of the Business and Career Solutions Centers.

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