"Job Search Allowance Application Form - Trade Adjustment Assistance" - Minnesota

Job Search Allowance Application Form - Trade Adjustment Assistance is a legal document that was released by the Minnesota Employment and Economic Development Department - a government authority operating within Minnesota.

Form Details:

  • Released on May 1, 2017;
  • The latest edition currently provided by the Minnesota Employment and Economic Development Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Minnesota Employment and Economic Development Department.

ADVERTISEMENT
ADVERTISEMENT

Download "Job Search Allowance Application Form - Trade Adjustment Assistance" - Minnesota

646 times
Rate (4.6 / 5) 39 votes
Trade Adjustment Assistance
JOB SEARCH ALLOWANCE APPLICATION – Part I
The goal of the TAA program is for workers to return to suitable employment, or to find work that will eventually pay as much or
more than the trade affected position. Suitable employment is defined as work that pays at least 80% of the wage earned with the
trade affected employer and utilizes the same skills.
A request for job search allowance must be submitted before the job search begins, and before the 365
th
day after layoff or
certification, whichever is later, or within 182 days following the conclusion of TAA approved training. Applicant must be
registered as a vendor with the State of Minnesota to receive job search reimbursements.
Reimbursement will be the lesser of:
Transportation receipts, or the Federal mileage rate
Meals and lodging receipts, or 50% of the prevailing per diem for the interview location.
Applicant Information
Name (First MI Last)
Home Address (Street, City, State, ZIP Code)
Last # SSN
Home Phone
Cell Phone
Date of Birth
WF1 ID No.
DW Enrollment Date
(mm/dd/yy)
(mm/dd/yy)
Petition Number
Email Address
Certified Employer Name
Employer Address (City, State)
Employment Agency/Contractor
Impact Date
(mm/dd/yy)
Certification Date
Expiration Date
Employment Start Date
Employment End Date
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
Dislocated Worker Counselor Information
Counselor Name
Agency Name
Email Address
Phone Number
Signature
TAA Applicant: The information contained in this request is correct and complete to the best of my knowledge. I
understand that I am subject to penalties should I willfully misrepresent information in order to obtain funding that I
am not entitled to. I further certify that the funds will be used for the intended purpose and that I will provide proof
of such expenditures as required.
Applicant Signature/Date
Dislocated Worker Counselor Signature/Date
TAA Use Only
Date Requested:
Open Activity in WF1
Estimated end date:
Request Procure-It for $1250
or $1500 depending on law
Page 1
Revised May 2017
Trade Adjustment Assistance
JOB SEARCH ALLOWANCE APPLICATION – Part I
The goal of the TAA program is for workers to return to suitable employment, or to find work that will eventually pay as much or
more than the trade affected position. Suitable employment is defined as work that pays at least 80% of the wage earned with the
trade affected employer and utilizes the same skills.
A request for job search allowance must be submitted before the job search begins, and before the 365
th
day after layoff or
certification, whichever is later, or within 182 days following the conclusion of TAA approved training. Applicant must be
registered as a vendor with the State of Minnesota to receive job search reimbursements.
Reimbursement will be the lesser of:
Transportation receipts, or the Federal mileage rate
Meals and lodging receipts, or 50% of the prevailing per diem for the interview location.
Applicant Information
Name (First MI Last)
Home Address (Street, City, State, ZIP Code)
Last # SSN
Home Phone
Cell Phone
Date of Birth
WF1 ID No.
DW Enrollment Date
(mm/dd/yy)
(mm/dd/yy)
Petition Number
Email Address
Certified Employer Name
Employer Address (City, State)
Employment Agency/Contractor
Impact Date
(mm/dd/yy)
Certification Date
Expiration Date
Employment Start Date
Employment End Date
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
(mm/dd/yy)
Dislocated Worker Counselor Information
Counselor Name
Agency Name
Email Address
Phone Number
Signature
TAA Applicant: The information contained in this request is correct and complete to the best of my knowledge. I
understand that I am subject to penalties should I willfully misrepresent information in order to obtain funding that I
am not entitled to. I further certify that the funds will be used for the intended purpose and that I will provide proof
of such expenditures as required.
Applicant Signature/Date
Dislocated Worker Counselor Signature/Date
TAA Use Only
Date Requested:
Open Activity in WF1
Estimated end date:
Request Procure-It for $1250
or $1500 depending on law
Page 1
Revised May 2017
Trade Adjustment Assistance
JOB SEARCH ALLOWANCE APPLICATION – Part II, Interview Details
Receipts for job search travel expense must be submitted within 30 days of the actual interview.
Applicant Information
Name (First MI Last)
Home Address (Street, City, State, ZIP)
Last # SSN
Preferred Phone
Email Address
Petition Number
Vendor ID
WF1 ID
DW Enrollment Date
(mm/dd/yy)
Prospective Employer Information
Verification of Job Search - The applicant has reviewed and provided the documentation required: (Please check the following)
Proof of scheduled interview (e.g., email or letter indicating invitation to interview with date and time)
Proof of interview attendance (business card, additional email exchange etc.)
Position meets “suitable employment” definition—https://apps.deed.state.mn.us//ddp/PolicyDetail.aspx?pol=174
Employer is outside local commuting distance from the applicant’s residence. (Check with TAA for current commuting
distance. Provide an internet map that confirms the distance from your residence on record and your new employer.)
Employer Name
Employer Address (Address, City, State, ZIP Code)
Employer Contact Name, Title
Employer Contact Phone
Employer Contact Email
Interview Position Title
Annual Salary for Interview Position
1
st
Interview Date
End date to receive receipts (30 days from interview)
(mm/dd/yy)
(mm/dd/yy)
Travel by car
Travel by Commercial Airline
Miles from residence to employer
TAA Use Only
*2002/2011/2015 Law: 90% of the total cost up to a total of $1,250
*2009 Law: 100% of the total cost up to $1,500
Transportation Expense (Check Actual Cost if applicant submits receipts or check Federal Mileage if no receipts.)
Actual Cost of transportation (receipts) or
Federal Mileage Rate X Round Trip miles (no receipts)
Federal Mileage Rate
Total Transportation Expense $
Lodging and Meals Expense (check Actual Cost if applicant submits receipts or per diem if no receipts)
Actual Cost of lodging and meals while in travel status (need receipts)
50% of the prevailing per diem allowance for the locality of the interview (no receipts required)
Total Lodging and Meals Expense $
*TOTAL TRAVEL EXPENSE—Transportation + Lodging and Meals X % per applicable law—see above.
This request for Search Allowance is approved.
State TAA Specialist/Date
Page 2
Revised May 2017
Page of 2