VA FM 22-8865 - APPR-OJT APPLICATION - FEDERAL.PDF

OMB Control No. 2900-0342
Respondent Burden: 90 minutes
EMPLOYER'S APPLICATION TO PROVIDE JOB TRAINING
AVN Department of Veterans Affairs
(UNDER TITLE 38 U.S. CODE SECTION 3677 OR 3687)
INSTRUCTIONS: All items should be completed. Information requested in Section II applies to the particular trade, craft or occupation for which
you propose to provide training to veterans and their eligible dependents. Please read Section III carefully before signing the application. The
completed application form may be submitted directly to the VA office serving the area where your establishment is located.
SECTION I - EMPLOYER IDENTIFICATION
1. NAME OF ESTABLISHMENT 2. NAME AND TITLE OF PERSON TO CONTACT 3. TELEPHONE NO.
(Include e-mail address) (Include Area Code)
4. LOCATION OF ESTABLISHMENT (Street No., Ci ty, State, Zip Code) 5. MAILING ADDRESS (If different than in Item 4)
SECTION II - DESCRIPTION OF TRAINING PROGRAM
6. JOB TITLE (Position for which training will be provided) 7. JOB DESCRIPTION (Please keep brief)
8. LENGTH OF PROGRAM 9. HOURS IN STANDARD WORK WEEK
(Indicate hours or months)
10. HOURS OF RELATED TRAINING 11. NUMBER OF FULLY QUALIFIED
OUTSIDE OF JOB REQUIRED EMPLOYEES AVAILABLE AS
EACH YEAR (If none, write "None") INSTRUCTORS FOR EACH TRAINEE
12. MAXIMUM NUMBER OF TRAINEES THAT CAN BE TRAINED AT ANY ONE TIME
SECTION III - WAGE PROGRESSION SCALE
13. BEGINNING WAGE FOR TRAINEES 14. PRESENT JOURNEYWORKER WAGE
15. WAGE PROGRESSION DURING TRAINING
A. PERIOD B. NO. OF MONTHS C. WAGE LEVEL A. PERIOD B. NO. OF MONTHS C. WAGE LEVEL
1ST $ PER 6TH $ PER
2ND $ PER 7TH $ PER
3RD $ PER 8TH $ PER
4TH $ PER 9TH $ PER
5TH $ PER 10TH $ PER
SECTION IV - CONDITIONS TO BE MET
I UNDERSTAND AND AGREE THAT THE FOLLOWING CONDITIONS MUST BE MET IF THIS TRAINING PROGRAM IS APPROVED
FOR VA TRAINING BENEFITS:
A. Close supervision by qualified journey workers will be provided throughout the training program.
B. Records will be maintained for each trainee. At a minimum, the records will include the following: job assignments, promotions, demotions, lay-
off terminations, rates of pay, progress in training as outlined in the work processes, hours of training given monthly in each process and overall
progress evaluations made at least each 3 months.
C. Credit will be given for previous training and experience and the length of the training program will be reduced proportionately. Trainees who are
granted credit for previous training and experience will be placed into the appropriate step of the wage progression scale.
D. If required for approval of a training program, the trainee will be advanced to the full journey worker wage immediately upon completion of the
training program.
E. An Enrollment Certification will not be submitted for a veteran or eligible person who is already qualified for the position because of prior training
or experience.
F. A copy of an approved training agreement will be provided to the trainee and to the Department of Veterans Affairs (VA).
G. Immediately notify VA of any wage increase (or decrease) paid any trainee not in accordance with his or her training agreement.
IN ADDITION, FOR ON-THE-JOB TRAINING OTHER THAN APPRENTICESHIP PROGRAMS, I HEREBY CERTIFY THAT:
H. The wages paid to trainees under this VA program will not be less than wages paid to trainees who are not eligible for VA benefits. The beginning
wage will be at least 50% of the wage for a fully trained employee.
I. Unless the training establishment is operated by a Federal, State or local government, periodic wage increases will be granted and by the last full
month of training the wage will be at least 85% of the wage for a fully trained employee.
J. There is a reasonable certainty that the job for which training is provided will be available to the trainee after training has been completed.
16. SIGNATURE 17. TITLE 18. DATE SIGNED
VA FORM 22-8865 EXISTING STOCKS OF VA FORM 22-8865, NOV 2007,
DEC 2010 WILL BE USED.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the
Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses as identified in the VA system of records, 58VA21/22/28,
Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. An example of
a routine use allows VA to send educational forms or letters with a veteran's identifying information to the veteran's school or training establishment to
(1) assist the veteran in the completion of claims forms or (2) for VA to obtain further information as may be necessary from the school for VA to
properly process the veteran's education claim or to monitor his or her progress during training. Your obligation to respond is required to obtain or retain
education benefits. While you do not have to respond, VA cannot determine if your training program can meet the requirements set by law for VA
approval unless the information is furnished. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to
verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine whether a training program may be approved by the Department of Veterans Affairs
(VA), (38 U.S.C. 3677 or 3687). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 90
minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid
OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control
numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain . If desired, you can call 1-888-0I-BILL-1
(1-888-442-4551) to get information on where to send comments or suggestions about this form.
VA FORM 22-8865, DEC 2010