Form ETA858A "Weekly Request for Allowance by Worker in Training" - Alabama

What Is Form ETA858A?

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

Form Details:

  • Released on September 1, 2012;
  • The latest edition provided by the Alabama Department of Labor;
  • 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 printable version of Form ETA858A by clicking the link below or browse more documents and templates provided by the Alabama Department of Labor.

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Download Form ETA858A "Weekly Request for Allowance by Worker in Training" - Alabama

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ALABAMA DEPARTMENT OF LABOR
FORM ETA 858A
UNEMPLOYMENT COMPENSATION DIVISION
TRAINING WEEK
ELECTRONIC
MONTGOMERY, AL
Beginning Week
Ending Date
(REV.09/12)
OPR: TRA/TAA
WEE
WEEKLY REQUEST FOR ALLOWANCE BY WORKER IN TRAINING
TRADE ADJUSTMENT EXTENSION ACT OF 2011
WORKER NAME (Last, First, Middle)
PETITION NO.
SOCIAL SECURITY NO.
MAILING ADDRESS (No., Street, City or County, State, Zip Code)
A. TRADE READJUSTMENT ALLOWANCE (To be completed by worker)
YES
NO
EXPLAIN ALL “YES” ANSWERS
1. HAVE YOU PREVIOUSLY RECEIVED A TRADE READJUSTMENT
DATE
NAME OF PROGRAM
ALLOWANCE OR ANY OTHER TRAINING ALLOWANCE FOR THE
RECEIVED AMOUNT
TRAINING WEEK SHOWN ABOVE (e.g., PELL GRANT, WIA)?
RECEIVED
$
2. HAVE YOU FILED (OR DO YOU INTEND TO FILE) A CLAIM, OR
TYPE OF CLAIM
HAVE YOU RECEIVED UNEMPLOYMENT INSURANCE UNDER A
PAYING STATE
STATE OR FEDERAL LAW FOR THE TRAINING WEEK OR ANY PART
OF THE TRAINING WEEK SHOWN ABOVE?
AMOUNT RECEIVED $
3. HAVE YOU WORKED IN EMPLOYMENT OR SELF‐EMPLOYMENT
GROSS EARNINGS PAID
$
DURING THE TRAINING WEEK SHOWN ABOVE?
NAME AND ADDRESS OF EMPLOYER
B. WORKER CERTIFICATION
I AUTHORIZE deduction for advances made to me, if appropriate. I GIVE this information to support my request for allowances. The information
contained in this request is correct to the best of my knowledge. I UNDERSTAND that penalties are provided for willful misrepresentation made to
obtain allowances to which I am not entitled.
Signature of Worker
Date
C. PROGRESS AND ATTENDANCE IN TRAINING (To be completed by Training Facility)
YES
NO
EXPLAIN ALL “NO” ANSWERS
1. FROM THE BEGINNING OF TRAINING AND THROUGH THE
REASON FOR UNSATISFACTORY PROGRESS
TRAINING WEEK SHOWN ABOVE, HAS THE WORKER MADE
SATISFACTORY PROGRESS IN TRAINING?
DATE TERMINATED
a.
IF “NO,” DID GOOD CAUSE EXIST FOR WORKER’S UNSATIS‐
LAST HOUR AND DATE ATTENDED
FACTORY PROGRESS IN TRAINING?
ABOVE?
2.
DID YOU PROVIDE LODGING AND MEALS TO THIS
IF “YES”, CHARGE PER DAY $
WORKER DURING THE TRAINING WEEK SHOWN
NO. OF DAYS PROVIDED
3. ATTENDANCE RECORD:
Enter “P” for each day the worker was absent for good cause and for each day the training facility did not conduct training.
Enter “A” for each day the worker was absent without good cause. Days the worker attended should be left blank.
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
NO. DAYS TRAIN‐
ING SCHEDULED
D. TRAINING FACILITY CERTIFICATION
The answers in Part C are in accordance with our records. Statements made by the worker appear to be complete and correct to the best of my knowledge.
NAME OF TRAINING FACILITY
SIGNATURE OF TRAINING OFFICIAL
DATE
ALABAMA DEPARTMENT OF LABOR
FORM ETA 858A
UNEMPLOYMENT COMPENSATION DIVISION
TRAINING WEEK
ELECTRONIC
MONTGOMERY, AL
Beginning Week
Ending Date
(REV.09/12)
OPR: TRA/TAA
WEE
WEEKLY REQUEST FOR ALLOWANCE BY WORKER IN TRAINING
TRADE ADJUSTMENT EXTENSION ACT OF 2011
WORKER NAME (Last, First, Middle)
PETITION NO.
SOCIAL SECURITY NO.
MAILING ADDRESS (No., Street, City or County, State, Zip Code)
A. TRADE READJUSTMENT ALLOWANCE (To be completed by worker)
YES
NO
EXPLAIN ALL “YES” ANSWERS
1. HAVE YOU PREVIOUSLY RECEIVED A TRADE READJUSTMENT
DATE
NAME OF PROGRAM
ALLOWANCE OR ANY OTHER TRAINING ALLOWANCE FOR THE
RECEIVED AMOUNT
TRAINING WEEK SHOWN ABOVE (e.g., PELL GRANT, WIA)?
RECEIVED
$
2. HAVE YOU FILED (OR DO YOU INTEND TO FILE) A CLAIM, OR
TYPE OF CLAIM
HAVE YOU RECEIVED UNEMPLOYMENT INSURANCE UNDER A
PAYING STATE
STATE OR FEDERAL LAW FOR THE TRAINING WEEK OR ANY PART
OF THE TRAINING WEEK SHOWN ABOVE?
AMOUNT RECEIVED $
3. HAVE YOU WORKED IN EMPLOYMENT OR SELF‐EMPLOYMENT
GROSS EARNINGS PAID
$
DURING THE TRAINING WEEK SHOWN ABOVE?
NAME AND ADDRESS OF EMPLOYER
B. WORKER CERTIFICATION
I AUTHORIZE deduction for advances made to me, if appropriate. I GIVE this information to support my request for allowances. The information
contained in this request is correct to the best of my knowledge. I UNDERSTAND that penalties are provided for willful misrepresentation made to
obtain allowances to which I am not entitled.
Signature of Worker
Date
C. PROGRESS AND ATTENDANCE IN TRAINING (To be completed by Training Facility)
YES
NO
EXPLAIN ALL “NO” ANSWERS
1. FROM THE BEGINNING OF TRAINING AND THROUGH THE
REASON FOR UNSATISFACTORY PROGRESS
TRAINING WEEK SHOWN ABOVE, HAS THE WORKER MADE
SATISFACTORY PROGRESS IN TRAINING?
DATE TERMINATED
a.
IF “NO,” DID GOOD CAUSE EXIST FOR WORKER’S UNSATIS‐
LAST HOUR AND DATE ATTENDED
FACTORY PROGRESS IN TRAINING?
ABOVE?
2.
DID YOU PROVIDE LODGING AND MEALS TO THIS
IF “YES”, CHARGE PER DAY $
WORKER DURING THE TRAINING WEEK SHOWN
NO. OF DAYS PROVIDED
3. ATTENDANCE RECORD:
Enter “P” for each day the worker was absent for good cause and for each day the training facility did not conduct training.
Enter “A” for each day the worker was absent without good cause. Days the worker attended should be left blank.
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
NO. DAYS TRAIN‐
ING SCHEDULED
D. TRAINING FACILITY CERTIFICATION
The answers in Part C are in accordance with our records. Statements made by the worker appear to be complete and correct to the best of my knowledge.
NAME OF TRAINING FACILITY
SIGNATURE OF TRAINING OFFICIAL
DATE