The document outlines terms and conditions for an employer to agree to regarding consortium training. It states that: 1) The Westmoreland-Fayette Workforce Investment Board will create an employer profile if one does not already exist and list the employer as a point of contact for matters related to the training. 2) The employer agrees to provide student information including name, SSN, gender, race, ethnicity, and worker status for all employees participating in the training in order for them to be eligible for reimbursement. 3) The completed form should be emailed or faxed to Greg Schwing at the Westmoreland-Fayette WIB by the authorized employer representative.

1. By completingthe above form,employeragreestothe followingtermsandconditions:
1) The Westmoreland-Fayette Workforce InvestmentBoard will establishanEmployerBusinessFolder(if one does
not alreadyexist) andwillenter asapointof contact in the CommonwealthWorkforce DevelopmentSystem
(CWDS) for all mattersrelatedtothiscontract and consortiumtraining.
2) Employeragreestoprovide the followinginformationforall registeredstudents:FirstName,LastName,SSN,
Gender,Race,Ethnicity,andWorkerStatus(IncumbentWorker,New Hire,orPre-EmploymentTrainee) forall
employeesparticipatinginconsortiumtraining. Withoutthisdata,the employee is noteligibleforWIB
reimbursement/participationinthe consortiumtraining. Thisdatawill be eithersubmittedviaasecure online
form,or via email/phonedirectlytothe WIB,and be keptconfidential andsecure. See “2010 Consortium
Training– Schedule andDetails”documentforinstructionsanddetailsaboutemployeeenrollmentandthe
submissionof thisdata.
3) Thisentire formshouldeitherbe emailedtoGregSchwing (gschwing@westfaywib.org),orfaxedtohis
attentionvia724-755-0914. Please contactGregSchwing directlywithquestionsorforassistance:724-755-2145
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Signature/Title –AuthorizedEmployerRep. Printedname Date