Form Wtw 16 - Grant-Based On-The-Job Training Participation: Voluntary Consent Form
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
GRANT-BASED ON-THE-JOB
PARTICIPANT NAME
TRAINING PARTICIPATION:
VOLUNTARY CONSENT FORM
CASE NAME
CASE NUMBER
I.D. NUMBER
WELFARE TO WORK WORKER NAME
This form is to help you decide if you want to volunteer to do grant-based on-the-job training (OJT). It lists your rights and
responsibilities if you accept the OJT assignment. Grant-based OJT is where all or part of your cash aid, or the savings from
your lowered aid because you are working, will be given to your employer. The employer will use your aid (or the savings) to
help pay for your wages. If you do not want to do grant-based OJT, you and your worker will decide what your Welfare-to-Work
assignment will be based on your background and employment plan.
GRANT-BASED ON-THE-JOB TRAINING (OJT) PARTICIPATION REQUIREMENTS
My initials below show that I have reviewed the following items with my worker and understand the rules for participation in a
grant-based OJT funded assignment.
Participation in a grant-based OJT assignment is voluntary.
The county welfare department (CWD) cannot take any action against me for refusing to agree to be assigned to a
grant-based OJT position.
The CWD will give all or part of my cash aid to my employer to pay all or part of my wages.
I will not receive the earned income disregard for wages that are paid from the cash aid given to my employer.
When I participate in a grant-based OJT assignment, my total monthly take-home pay may be less than the amount
I would usually get as cash aid.
The amount of my cash grant will be based on the expected earnings from my grant-based OJT assignment.
The monthly total of my gross wages (the amount I am paid before taxes and other payments are taken out) plus my cash
aid, if any, should be as much as or more than the amount I would get as cash aid if I did not take the grant-based OJT
position.
If the county pays me a corrective underpayment because my employer does not pay me for all the hours that I work, and I
later collect the wages due from the employer, I will pay the county back for as much of the corrective underpayment as I
receive in back wages from the employer. If I do not return the money the county will consider this an overpayment.
If I agree to a grant-based OJT assignment, I am still a CalWORKs recipient. I must comply with Welfare-to-Work
requirements.
Failure to meet the rules of the grant-based OJT assignment without a good reason will result in a sanction and my cash
aid may be lowered. Some reasons why I may be sanctioned and have my cash aid stopped or lowered are: failing to
meet the work rules, failing to show up for work, tardiness, failing to follow procedures, failing to make satisfactory progress
in my job, etc.
If I do not meet the assignment rules, I have the right to give a good reason for not participating so I do not get sanctioned
and have my cash aid lowered. The following are some good reasons for not meeting my participation rules or completing
my assignment:
·
Lack of supportive services (such as childcare, transportation, tools, clothing required for the job, books, and other
necessary job related costs).
·
Past or current victim of domestic abuse (such as physical, sexual, or psychological abuse).
·
The daily or weekly hours of work are more than the hours in my assignment agreement.
·
Acceptance of a full-time unsubsidized job.
·
The Welfare-to-Work Handbook that is part of my Welfare-to-Work Plan gives more information on reasons for not
participating in my grant-based OJT assignment.
I can file for a state hearing if I do not agree with any CWD action.
PAGE 1
WTW 16 (12/05) GRANT-BASED OJT VOLUNTARY CONSENT (1 of 2) - REQUIRED FORM - SUBSTITUTE PERMITTED
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