"Application for Self-employment Assistance Program (Seap)" - Washington

Application for Self-employment Assistance Program (Seap) is a legal document that was released by the Washington State Employment Security Department - a government authority operating within Washington.

Form Details:

  • Released on December 1, 2014;
  • The latest edition currently provided by the Washington State Employment Security 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 printable version of the form by clicking the link below or browse more documents and templates provided by the Washington State Employment Security Department.

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Download "Application for Self-employment Assistance Program (Seap)" - Washington

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Application for Self-Employment
Assistance Program (SEAP)
Name
SSN or claimant ID number
Phone number
(
)
Claimant’s name and address:
Return this form by fax at 800-301-1796 or mail it to:
Employment Security Department
PO Box 19019
Olympia, WA 98507-0019
We need this information to make a decision about your unemployment claim. After we receive your response,
we will contact you by phone if we need additional information.
You have the right to an interview by telephone or in person before a decision is made. If you want an
interview, contact the claims center. You may have any person, including an attorney, assist you at the
interview. You may present evidence, documents, or witnesses; cross-examine witnesses or parties present; and
ask for a copy of all records or documents on the issue.
Please complete and return this questionnaire to the address above.
You may be eligible to participate in the Self-Employment Assistance Program (SEAP) while receiving
unemployment benefits. For a list of approved providers, go to
www.esd.wa.gov/jobs-and-training/SEAP-
approved-providers
or contact your nearest WorkSource employment center.
If approved for SEAP, you do not have to look for work while participating in the training program. We will
decide if you can be approved based on your answers to these questions.
Note: We do not pay for books, tuition or program-related fees. Approval does not extend the number of weeks
you can collect unemployment benefits. Your unemployment benefits may run out before the end of your
program. If you have questions about SEAP or this application you may call the Training Benefit Unit at 877-
600-7701 or email your questions to
seacat@esd.wa.gov
.
Section 1 -- Self-Employment Assistance Program information
1. Program provider information:
Name: ____________________________________________________________________________
Address: __________________________________________________________________________
Phone number: _____________________________________________________________________
Program contact person: _____________________________________________________________
2. Program name: ________________________________________________________________________
3. Program start date: _____________________________________________________________________
4. Program end date: ______________________________________________________________________
(This includes all elements of the program: structured curriculum, business counseling, technical assistance, and
requirements to engage in activities relating to setting up a business and becoming self-employed.)
Self-Employment Assistance Program (SEAP) Application
Page 1 of 3
(Rev. 12/2014)
Application for Self-Employment
Assistance Program (SEAP)
Name
SSN or claimant ID number
Phone number
(
)
Claimant’s name and address:
Return this form by fax at 800-301-1796 or mail it to:
Employment Security Department
PO Box 19019
Olympia, WA 98507-0019
We need this information to make a decision about your unemployment claim. After we receive your response,
we will contact you by phone if we need additional information.
You have the right to an interview by telephone or in person before a decision is made. If you want an
interview, contact the claims center. You may have any person, including an attorney, assist you at the
interview. You may present evidence, documents, or witnesses; cross-examine witnesses or parties present; and
ask for a copy of all records or documents on the issue.
Please complete and return this questionnaire to the address above.
You may be eligible to participate in the Self-Employment Assistance Program (SEAP) while receiving
unemployment benefits. For a list of approved providers, go to
www.esd.wa.gov/jobs-and-training/SEAP-
approved-providers
or contact your nearest WorkSource employment center.
If approved for SEAP, you do not have to look for work while participating in the training program. We will
decide if you can be approved based on your answers to these questions.
Note: We do not pay for books, tuition or program-related fees. Approval does not extend the number of weeks
you can collect unemployment benefits. Your unemployment benefits may run out before the end of your
program. If you have questions about SEAP or this application you may call the Training Benefit Unit at 877-
600-7701 or email your questions to
seacat@esd.wa.gov
.
Section 1 -- Self-Employment Assistance Program information
1. Program provider information:
Name: ____________________________________________________________________________
Address: __________________________________________________________________________
Phone number: _____________________________________________________________________
Program contact person: _____________________________________________________________
2. Program name: ________________________________________________________________________
3. Program start date: _____________________________________________________________________
4. Program end date: ______________________________________________________________________
(This includes all elements of the program: structured curriculum, business counseling, technical assistance, and
requirements to engage in activities relating to setting up a business and becoming self-employed.)
Self-Employment Assistance Program (SEAP) Application
Page 1 of 3
(Rev. 12/2014)
Name
SSN or claimant ID number
5. What business are you going to pursue? ____________________________________________________
6. Do you already have a business? __________________________________________________________
7. What is your Unified Business Identifier (UBI)#? ____________________________________________
8. List the occupation in which you have the most experience: _____________________________________
How many years did you work in this occupation? ____________________________________________
9. Do you have any injuries, illnesses, or other conditions that prevent you from returning to your main
occupation? If you have medical documentation to support this, please attach a copy (not required).
Yes
No
If yes, please explain:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
10. List any other significant occupation and years of experience: ___________________________________
11. List your last three jobs, beginning with the most recent:
Business name
Occupation
Start date
End date
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Self-Employment Assistance Program (SEAP) Application
Page 2 of 3
(Rev. 12/2014)
Name
SSN or claimant ID number
Section 2 -- Applicant certification
I am applying for approval to participate in SEAP. I understand this information may be verified and
that I must immediately report any changes in my training plan to the Training Benefit Unit at
877-600-7701. If I am approved for benefits, I understand that if I later change my training program
without prior approval from the Employment Security, I may be denied benefits and have to pay back
any benefits I was not entitled to receive.
I understand that I may be contacted by the department in the future and I agree to provide information to the
research team regarding my SEAP participation.
I authorize my program provider to release information to Employment Security about my enrollment
and participation in the program.
I understand that I must continue to look for work unless I am notified that I am approved.
The information I provided is true to the best of my knowledge.
Signature ___________________________________________________ Date _________________________
Phone ___________________________________________________________________________________
Program provider certification
I have reviewed Section 1 of this application. The information provided is correct to the best of my knowledge.
The applicant has the skills, ability, aptitude and resources to successfully complete our self-employment
assistance program.
We will certify to the applicant’s full-time participation in our program as required.
Signature ___________________________________________________ Date _________________________
Title/Position ________________________________________________ Phone ________________________
Email address______________________________________________________________________________
The Employment Security Department is an equal-opportunity employer and provider of programs and services. Auxiliary aids
and services are available upon request to people with disabilities. Auxiliary aids may include qualified interpreters and
telecommunication devices (TTY) for hearing- or speech-impaired individuals. Individuals with limited English proficiency may
request free interpretive services to conduct business with the department.
Self-Employment Assistance Program (SEAP) Application
Page 3 of 3
(Rev. 12/2014)
Page of 3