Form MODES-SW-1 "Shared Work Plan Application" - Missouri

What Is Form MODES-SW-1?

This is a legal form that was released by the Missouri Department of Labor and Industrial Relations - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the Missouri Department of Labor and Industrial Relations;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MODES-SW-1 by clicking the link below or browse more documents and templates provided by the Missouri Department of Labor and Industrial Relations.

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Download Form MODES-SW-1 "Shared Work Plan Application" - Missouri

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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
573-751-WORK
SHARED WORK PLAN APPLICATION
www.SharedWork.mo.gov
AGENCY USE ONLY
PLAN NO.
A. EMPLOYER INFORMATION
1. Employer Name
2. Missouri Employer Account No.
3. Missouri Location Address
4. Telephone No. (Include Area Code)
3a. Complete Mailing Address
5. Affected Unit
6. Number of Workers
7. Number of Affected Workers
8. Estimate the number of employees that would be laid off if there were no participation in the Shared Work Program
9. Do you certify the Shared Work Plan describes the manner in which employees in the affected unit will be notified and
that advanced notice will be given?
Yes
No
If No, explain why it was not feasible to provide advanced notice:
B. EMPLOYER CERTIFICATION
I certify that fringe benefits shall continue to be provided to participating employees under the same terms and conditions as
though the employee’s normal hours had not been reduced or to the same extent as other employees not participating in the Shared
Work Program. I certify that participation in the Shared Work Program and its implementation is consistent with my obligation
under applicable federal and state laws. I understand that the Shared Work Program will not be denied to employees in training
that is approved by the director, such as employer-sponsored training or training funded under the Workforce Investment Act of
1998. I understand that I must file a certification of hours worked at least every two weeks for those employees whose hours have
been reduced under the Plan. I certify our plan will reduce hours by 20 to 40 percent. I certify that the implementation of this
Shared Work Plan, and the resulting reduction in work hours, is in lieu of layoffs that would apply to at least 10 percent of the
affected unit.
Employer or Representative
Title
Signature
Date
C. COLLECTIVE BARGAINING INFORMATION
(Complete only if the affected workers are members of a union.)
Union Name
Local No.
Union Official
Title of Official
Signature
Date
FOR AGENCY USE ONLY - DO NOT COMPLETE BELOW THIS LINE
Employer Current:  Yes  No
Initials _____________________
Date ________________________
Determinations:  Denied
 Approved
Beginning _____________________ Ending _______________________
(Mo., Day, Yr.)
(Mo., Day, Yr.)
Reason for denial: ___________________________________________________________________________________________
________________________________________________________________
___________________________________
(Director)
(Date)
IMPORTANT: If needed, call 573-751-6548 for assistance in the translation and understanding of the information in this document.
¡IMPORTANTE!: Si es necesario, llame al 573-751-6548 para asistencia en la traducción y entendimiento de la información en este documento.
Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and services
are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711
MODES-SW-1 (04-17)
Benefits
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
573-751-WORK
SHARED WORK PLAN APPLICATION
www.SharedWork.mo.gov
AGENCY USE ONLY
PLAN NO.
A. EMPLOYER INFORMATION
1. Employer Name
2. Missouri Employer Account No.
3. Missouri Location Address
4. Telephone No. (Include Area Code)
3a. Complete Mailing Address
5. Affected Unit
6. Number of Workers
7. Number of Affected Workers
8. Estimate the number of employees that would be laid off if there were no participation in the Shared Work Program
9. Do you certify the Shared Work Plan describes the manner in which employees in the affected unit will be notified and
that advanced notice will be given?
Yes
No
If No, explain why it was not feasible to provide advanced notice:
B. EMPLOYER CERTIFICATION
I certify that fringe benefits shall continue to be provided to participating employees under the same terms and conditions as
though the employee’s normal hours had not been reduced or to the same extent as other employees not participating in the Shared
Work Program. I certify that participation in the Shared Work Program and its implementation is consistent with my obligation
under applicable federal and state laws. I understand that the Shared Work Program will not be denied to employees in training
that is approved by the director, such as employer-sponsored training or training funded under the Workforce Investment Act of
1998. I understand that I must file a certification of hours worked at least every two weeks for those employees whose hours have
been reduced under the Plan. I certify our plan will reduce hours by 20 to 40 percent. I certify that the implementation of this
Shared Work Plan, and the resulting reduction in work hours, is in lieu of layoffs that would apply to at least 10 percent of the
affected unit.
Employer or Representative
Title
Signature
Date
C. COLLECTIVE BARGAINING INFORMATION
(Complete only if the affected workers are members of a union.)
Union Name
Local No.
Union Official
Title of Official
Signature
Date
FOR AGENCY USE ONLY - DO NOT COMPLETE BELOW THIS LINE
Employer Current:  Yes  No
Initials _____________________
Date ________________________
Determinations:  Denied
 Approved
Beginning _____________________ Ending _______________________
(Mo., Day, Yr.)
(Mo., Day, Yr.)
Reason for denial: ___________________________________________________________________________________________
________________________________________________________________
___________________________________
(Director)
(Date)
IMPORTANT: If needed, call 573-751-6548 for assistance in the translation and understanding of the information in this document.
¡IMPORTANTE!: Si es necesario, llame al 573-751-6548 para asistencia en la traducción y entendimiento de la información en este documento.
Missouri Division of Employment Security is an equal opportunity employer/program. Auxiliary aids and services
are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711
MODES-SW-1 (04-17)
Benefits