Form SFN 14095 On-The-Job Training Proposal Form - North Dakota

Form SFN14095 is a Job Service North Dakota form also known as the "On-the-job Training Proposal Form". The latest edition of the form was released in July 1, 2015 and is available for digital filing.

Download a PDF version of the Form SFN14095 down below or find it on Job Service North Dakota Forms website.

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ON-THE-JOB TRAINING PROPOSAL
JSND / WORKFORCE PROGRAMS
SFN 14095 (R. 7-15)
Job Service North Dakota will help you develop a training program. As an employer, you are paid for
training costs up to 50 percent of the trainee’s wage. You receive this payment each month after you
submit an invoice. There is a minimum amount of record keeping. At the end of the training program,
you know you have a well-trained worker because you trained that worker yourself. Important: The
employee may not begin working prior to negotiation of the On-the-Job Training (OJT) Program contract
and required signatures have been obtained. Failure to comply with this will nullify the contract and may
result in legal action against your business.
Name of Business
Street Address / PO Box
City
State
ZIP Code
Mailing Address (if different than above)
City
State
ZIP Code
Training Program Position Title
E-mail Address
Cell Phone Number
Telephone Number
Federal Tax Identification Number
Number of Full-Time Employees
Please check the box(es) that apply to your agency or business:
Corporation
Individual Ownership
Partnership
Public Agency
Nonprofit Organization
Other
How many hours per week will the trainee work?
What is the business product or service?
Number of Positions Requested
Proposed Starting Wage per Hour
Proposed Starting Date
Proposed Wage at End of Training
List major job duties and / or areas in which the employee will receive training. List the most important
duties (up to a maximum of seven). Also list the approximate percentage of the trainee’s time needed to
learn each job duty.
Total Trainee Hours
100%
ON-THE-JOB TRAINING PROPOSAL
JSND / WORKFORCE PROGRAMS
SFN 14095 (R. 7-15)
Job Service North Dakota will help you develop a training program. As an employer, you are paid for
training costs up to 50 percent of the trainee’s wage. You receive this payment each month after you
submit an invoice. There is a minimum amount of record keeping. At the end of the training program,
you know you have a well-trained worker because you trained that worker yourself. Important: The
employee may not begin working prior to negotiation of the On-the-Job Training (OJT) Program contract
and required signatures have been obtained. Failure to comply with this will nullify the contract and may
result in legal action against your business.
Name of Business
Street Address / PO Box
City
State
ZIP Code
Mailing Address (if different than above)
City
State
ZIP Code
Training Program Position Title
E-mail Address
Cell Phone Number
Telephone Number
Federal Tax Identification Number
Number of Full-Time Employees
Please check the box(es) that apply to your agency or business:
Corporation
Individual Ownership
Partnership
Public Agency
Nonprofit Organization
Other
How many hours per week will the trainee work?
What is the business product or service?
Number of Positions Requested
Proposed Starting Wage per Hour
Proposed Starting Date
Proposed Wage at End of Training
List major job duties and / or areas in which the employee will receive training. List the most important
duties (up to a maximum of seven). Also list the approximate percentage of the trainee’s time needed to
learn each job duty.
Total Trainee Hours
100%
YES
NO
Does your business participate in any other training program(s) from which employees
can earn special certifications?
If “
,” please explain.
YES
Is this a new position in the company?
Is this an entry-level position?
Do you have a person in mind for the training?
Has he / she worked for you before?
If “
,” list name
YES
Is he / she a relative?
If “
,” what is the relationship?
YES
Will you continue to employ this person full time after the successful completion of
training?
Do you have a collective bargaining agreement or union contract?
If “
,” what is the name of the union?
YES
Is this position included in the agreement?
Is your company involved in a strike, walkout, or lockout?
Is this a seasonal job?
Do you currently have a federally funded training contract?
If “
,” please explain.
YES
Do you have a written complaint or grievance procedure?
Do you currently owe any unemployment insurance taxes or workers compensation
premiums? (OJT contracts cannot be negotiated with delinquent companies unless a
payment agreement has been established with Job Service North Dakota.)
Have you laid-off or terminated any employees in this or another similar position?
If “
,” please explain.
YES
List fringe benefits offered to permanent employees.
Have you or do you plan to reduce the hours of any full-time or part-time employees as a
result of this contract?
If “
,” please explain.
YES
Are uniforms required for the job?
If “
,” are employees required to buy them?
YES
Training Location Address if Different Than Business Address
City
State
ZIP Code
Name of Person Doing Training
Title
Number of Years of
Training Experience
YES
NO
Has your company relocated in the last 120 days and laid-off employees?
If “
,” please explain.
YES
Are time and attendance records kept?
If “
,” please explain how.
YES
Does your company contract with a payroll service to issue employee paychecks?
Explain the need for an On-the-Job Training Program.
Do you have any additional in-house training programs?
If “
,” please explain.
YES
Do you have a training program registered with the Office of Apprenticeship, Training,
Employer, and Labor Services (OATELS) , formerly Bureau of Apprenticeship and
Training?
If the job qualifies for apprenticeship, OATELS will be notified that Job Service North Dakota is
contracting for training in that occupation. (OATELS is non-union affiliated.)
Name of bookkeeper or person in charge of financial records. (Optional)
Telephone Number
Name of person who has authority and will be signing contract.
Title
I understand that:
■ Tools and equipment will not be purchased directly by Job Service North Dakota.
■ Workforce Investment Innovation and Opportunities Act funds cannot be used for political activities, to
support any religious group,
or to promote or oppose unionization.
■ In the event of a layoff in the training-related area, the OJT trainee must be the first person to be laid
off. (Your Job Service North Dakota representative can provide additional information.)
■ The information I have provided on this form is true and correct to the best of my knowledge and belief.
Signature
Date
Please complete and return to:
Job Service North Dakota is an equal opportunity employer / program provider.
Auxiliary aids and services are available upon request to individuals with disabilities.

Download Form SFN 14095 On-The-Job Training Proposal Form - North Dakota

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