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Home My WebLink About870251.tiff RESOLUTION RE: APPROVE AMENDMENTS TO THE WELFARE DIVERSION PROGRAM POLICIES AND PROCEDURES WHEREAS , the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board of County Commissioners of Weld County, Colorado, did, on the 26th day of March, 1984 , adopt Welfare Diversion Program Policies and Procedures , and WHEREAS , the Board has now been presented with certain amendments to the Welfare Diversion Program Policies and Procedures for review and approval , and WHEREAS , after , review, the Board deems it advisable to approve said amendments to the Policies and Procedures , a copy being attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the amendments to the Welfare Diversion Program Policies and Procedures be, and hereby are, approved. The above and foregoing Resolution was, on motion duly made and seconded , adopted by the following vote on the 8th day of April, A.DDJ. , 1987 . BOARATTEST;111164,44.4e �'J WELDDCOUNTY,OF COLORADO OLOR DOTY SSIONERS Weld County Clerk and Recorder EXCUSED and Clerk to the Board Gordon E. Lacy, Chairman \B l/1 ��y�i4 c l C. Kirb , Pr Tem eputy County lerk APPROVED AS TO FORM: Gene R. B antner Ja que ' ne J k nson ' County Attorney Fra /Zp2 870251 rl mEmORAnDUm Gordon E. Lacy, Chairman Wilk To Board of County Commissioners Dare _ April_• J987 COLORADO From Walter J. Speckman, Executive Director 'MI Subject. Amended Welfare Diversion Policies and Procedures Enclosed for Board approval are the Welfare Diversion Policies and Procedures that have been revised as necessary with the change in regu- lations. A copy was submitted for review and comment to Jacqueline Johnson, Bruce Barker, Eugene McKenna, and Jim Poppe. We received suggested changes from all and those changes were included in the revised policies and procedures. If you have any questions, please telephone me at 353-0540. y re t9,70251. Weld Count) Jivision of Human Resources and .)ocial Services POLICIES AND PROCEDURES 87-i Section: Welfare Diversion Program Policy Number: Subject: Table of Contents Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 1 Walter J. Speckman Page Part A: Program Overview 1. Purpose of the Policy and Procedures Manual 1 2. Goals and Objectives of the Welfare Diversion Program 2 3. Federal and State Reimbursement to the Welfare Diversion Program 4 Part B: Weld County Department of Social Services Procedures 1. Referral and Selection 1 2. Initial Application-Taking Procedures 3 3. Participation and Termination Procedures 8 4. Medicaid 12 5. Day Care 13 Part C: Employment Services of Weld County (ESWC) Procedures 1. ESWC Initial Application-Taking Procedures 1 2. AFDC Volunteer Participation in the Welfare Diversion Program . . 29 3. Orientation 30 4. Leave-Without-Pay 46 5. Employability Development Plan 47 6. Medical Evaluations 50 7. Payroll 56 8. Employee Evaluation 59 9. Employee Counseling Form 61 870251 Page ii Page 10. Counselor's Notes 63 11. Job Search Policy 65 12. Transportation Policy 71 13. Compensatory Time 72 14. Snow Days and Other Extreme Weather Conditions 73 15. Worksite Description and Non-Financial Agreement 74 16. Private Sector Internship Procedure 77 Part D: On-The-Job-Training Procedures 870251 Weld Counts Division of Human Resources and octal Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-Al Subject: Purpose of the Policy and Procedures Manual Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 1 Walter J. Speckman The Welfare Diversion Program Policies and Procedures Manual has been developed as a guide for the day-to-day administration of the Welfare Diversion Program. The Manual is designed to be used by the respective staffs of the Weld County Division of Human Resources and Weld County Department of Social Services. These written policies and procedures are designed to increase under- standing and to help assure uniformity of application of the policies and procedures contained herein. These policies and procedures are exclusive and supercede any policies and procedures established or promulgated by any persons other than the Board of County Commissioners of Weld County. The Board of County Commissioners of Weld County reserves the sole right to modify, revoke, suspend, terminate, or change any or all such policies and procedures in this Manual , in whole or in part, at any time, with or without notice. This Manual , any portion thereof, and any language contained in it is not intended to create, nor shall it constitute, a contract between the Weld County Board of County Commissioners and any person in any way associated with the Welfare Diversion Program. All policies in the Manual will be administered in accordance with Equal Employment Opportunity laws, the Federally approved 1115 Waiver Request, Colorado State Regulations (12.500-12500.5), Job Training Partnership Act, the Weld County Home Rule Charter, and related regulations. 870251 Weld County Division of Human Resources and Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-A2 Subject: Goals and Objectives of the Welfare Diversion Program Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 2 Walter J. Speckman The Weld County Welfare Diversion Program is designed to offer the eligible Aid to Families with Dependent Children (AFDC) applicant/recipient an eight (8) week work experience position. This work experience is a 40 hour per week minimum wage job which includes a job search component. The offer of a job is a viable test that eliminates applicants/recipients who are not available for work or who have other alternatives besides AFDC and choose those alternatives rather than AFDC. The major emphasis for Welfare Diversion is to help the participant obtain an unsubsidized job. Programmatic support in terms of job search, counseling, short term work experience, instructional training, skill development training, etc. , all revolve around the obtainment of an unsubsidized job. The major objectives of the Weld County Welfare Diversion Program are to: 1. Reduce the AFDC caseload by providing a positive alternative to job ready applicants in order to decrease their dependence on public assistance. 2. Integrate, consolidate, and coordinate all existing employment and training funds (Job Service, Job Training Partnership Act, and the Community Work Experience Program) for this effort in order to provide a cost effective employment program. 3. Demonstrate that the approved 1115 Federal Waiver will benefit the participants and increase the future successful implementation of the Welfare Diversion Program. 4. Demonstrate the cost effectiveness of the Welfare Diversion Program with the acquired waivers from both the State and Federal government. 5. Demonstrate that with the waivers, the participants will have an increased potential to successfully be diverted from public assistance. 6. Demonstrate that with resource flexibility (waivers), current resources can be used to make Welfare Diversion a more positive and successful option for both the State, Federal , and local govern- ment, as well as for the participants. 7. Demonstrate that no additional federal funding is needed to have success with clients and/or welfare caseloads. 870251 Page 3 8. Allow the State to encourage the utilization of Welfare Diversion to other counties by noting its demonstrated affect on the AFDC caseloads. 9. Encourage the placement of applicants through the increased use of On-the-Job Training positions. 870251 Weld Count) Division of Human Resources and .-ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-A3 Subject: Federal and State Reimbursement to the Welfare Date: March, 1987 Diversion Program 4 Department Head Concurrence: Eugene McKenna Page: Walter J. Speckman 1. Both the Federal and State government share of the AFDC grant that each family would have received had the family not been diverted will be used for the Welfare Diversion Program wage pool . 2. Reporting for a monthly Welfare Diversion Program reimbursement will be accomplished through the following established procedure: a. On the first week of each month, Social Services will supply the names and Social Security Numbers (SSN) of those Welfare Diversion referrals enrolled in the previous month. b. The Fiscal Department will research each name and identify the gross salary amounts paid for every Welfare Diversion Program participant for that specific month. Included will be those Welfare Diversion participants that are on an On-the-Job-Training contract. This information will be returned to Weld County Department of Social Services by the 15th of the month. c. Weld County Social Services will submit the reimbursement list to the Board of County Commissioners for signature. The list will then be forwarded to the State Department of Social Services for reimbursement. 3. The method of reimbursement is described in the following flow chart, which outlines the procedure for reimbursement. 870251 Page 5 - - Flow Chart Weld County Welfare Diversion Program - AFDC Reimbursement Monthly list of eligibles diverted NII Fiscal reviews the roster and compares the during the month is sent from participant information with the payroll. Weld County Social Services to •I Fiscal. List contains for each eligible the following: Fiscal adds to the ist all clients that . Name were diverted in previous months that are . Social Security Number still on the program. . Address . Name of program being diverted from, i.e., AFDC Fiscal lists the t al amount of wages paid County Social Services to each participant for the month and receives completed listing verifies the following information on each and verifies the following County Social Sery ces adds the client: information on clients following to the roster: , added to the list by the . Name Fiscal Department: . Household Number . Social Security Number . Number of adults and children . Name of program being diverted from, i.e., . Name in household AFDC . Social Security Number . Voluntary/Mandatory status . Type of Program, i.e., work experience or . Address . Denotes the clients who were On-The-Job Training . Name of program being reported and billed in diverted from, i.e., previous months I AFDC . Denotes the grant amount The State Departmen of Social Services reviews every client on the list and calculates the information provided by the County Department of Social Services. Verification s completed County Social ervices sends by the State Department of the completed list to the Social Services State Department of Social Services. The list is sent on a monthly basis. Errors Yes on Report No State Department processes a check for reimbursement (both State and Federal). P State will bill Feds in tate Department of Social Services contacts, standard format. via telephone, the County Department of Social Services. The following information is given to the County Department: Reimbursementk is . Name and Social Security Number of client sent to County Department . Specific reason why the State believes of Social Services there is a discrepancy . Any additional information to support the County decision to divert the client County Departmen submits check to the Board of County Commissioners for The County Deaprtmen reviews the State deposit in the County Department's concern and provides additional General Fund. information to the State Department to support their claim. State Department notifies The Board of ounty County Department that they Commissioners transfers cannot provide reimbursement the reimbursement amount for specific clients and from the County General reduces the reimbursement Add'l Fund to the HRD Fund. amount accordingly. Documentatio No Si upports Clai Yes HRD utilizes he monies received for additional programmatic functions for the Welfare Diversion Program. 870251 Weld County Jivision of Human Resources and _Jcial Services • POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-61 Subject: Referral and Selection Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 1 Walter J. Speckman 1. Referral AFDC grant applicants and recipients with children 6 months of age or older shall be referred to the Welfare Diversion Program and may be required to participate in Welfare Diversion. In addition, other AFDC applicants and recipients may volunteer to participate in Welfare Diversion. 2. Prioritization of Referral Priority shall be given to applicants and shall be based on the number of adult and youth slots as identified by Employment Services of Weld County (ESWC). The definition of Youth is single parents age 14 through 21 (Youth in secondary school will not be a priority for referral to the program). The definition of Adult is single parents age 22 and over. Priority classification is as follows: a. AFDC volunteer applicants b. AFDC mandatory applicants c. AFDC volunteer recipients d. AFDC mandatory recipients 3. Selection Criteria The criteria to be used by the Weld County Department of Social Services and ESWC to determine which individuals are selected for participation in the Welfare Diversion Program is as follows: a. Only those households which will receive greater benefits from net wages and food stamps, from their participation in the Welfare Diversion Program, than they would receive from their assistance grant and food stamps will be referred to ESWC. Also taken into consideration are any day care costs which would be paid by the diversion participant. (Net wage is defined as gross wage minus FICA, and state and federal taxes). b. A single parent who has a dependent child under the age of 6 months will not be required to participate. c. The family has no significant barriers to employment based on, but not limited to: - Incapacity or illness that would prevent participation for the duration of the incapacity or illness. The incapacity 870251 Page 2 or illness must be verified by Weld County Social Services after a physician selected by the Weld County Department of Social Services has completed a physical evaluation report. The doctor will outline specific tasks or jobs that the recipient can and cannot perform; - The person is a single parent with a child who is mentally or physically disabled to the degree that it prevents the parent from working; - The assignment is not within the person's mental or physical capacity; - The illness of a family member necessitates emergency care, as verified by a doctor's statement; - Breakdown of transportation arrangements, with no readily accessible means of transportation; - Court required appearance or incarceration; - Appropriate day care not available; - Unpaid medical bills of a sizeable/significant amount incurred during the three (3) months prior to application, which would be a benefit of Medicaid, shall be considered a temporary barrier to diversion participation or employment if the applicant met applicable AFDC eligibility requirements at the time the medical care services were received. The Weld County Department of Social Services may either pay the medical bills out of county funds and immediately divert the individual or approve the individual 's application for AFDC, thereby providing the three (3) month retroactive medical eligibility. e. Diversion worksite(s) must be available at the time of referral. f. AFDC mandatory applicants enrolled in an educational component will be referred to Employment Services of Weld County. The employment technician will determine mandatory/exempt status based on the outlook for employment in their area of education as determined by employment listings with the Job Service. 870251 Weld Count) division of Human Resources and social Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-B2 Subject: Initial Application Taking Procedures Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 3 Walter J. Speckman 1. Social Services will take the application for AFDC, make the initial eligibility determination, and make the initial determination of mandatory/volunteer status based on the age of the children. 2. AFDC applications will be taken from 8:15 a.m. to 2:00 p.m. at the Weld County Department of Social Services. If the applicant resides outside of Greeley, Social Services will accept applications until 5:00 p.m. (Monday, Tuesday, Thursday and Friday). AFDC applicants will be offered employment on the day they apply for AFDC and will be referred to the Employment Services of Weld County at the Division of Human Resources for a 1:15 p.m. registration and employer orientation. The applicant should expect the appointment to last from 1:15 p.m. to 5:00 p.m. Social Services will refer the AFDC recipient for entry into the Welfare Diversion Program on a date that will avoid duplication of payments from a public assistance grant and Welfare Diversion wages. This will be the second to last working day of the month. Final participant selection for the Welfare Diversion Program will be be based on the "Selection Criteria" as previously described. 3. At the time of referral to the Welfare Diversion Program, the Social Services Technician should inform the AFDC applicant of the following: (a) The day care resources available from the Weld County Department of Social Services. (b) Children can not be taken to the 1:15 p.m. appointment at the Employment Services of Weld County. The applicant is responsible for arranging day care for the appointment and throughout their term of employment. (c) It is the applicant's responsibility to inform Employment Services of Weld County if unable to attend the 1:15 p.m. appointment. (d) The day after orientation will be a leave-without-pay day in order to arrange for day care and transportation. Applications for day care assistance will be available from 1:00 p.m. to 2:00 p.m. at the Department of Social Services. (d) The AFDC sanctions for refusal to participate, and the need to reapply to get AFDC for the children only. 870251 page 4 (e) The opportunity for a "second chance" within the three (3) day requirement. (f) The applicant will sign and receive a copy of the Appointment to Report to Work Form (Attachment A). The signed form will be attached to the Welfare Diversion Registration Form (Attachment B) , which is used by Social Services as a referral form. 4. A representative from Human Resources will pick up the Welfare Diversion Registration Form, and the signed Appointment to Report to Work Form. 5. Applicants who are not eligible for AFDC on the date of application, but will be eligible within 30 days, will be referred on the date of their eligibility to start work. 870251 Attachment A Page 5 Appointment to Report to Work Your appointment for entry into the Welfare Diversion Program is scheduled for 1:15 p.m. on , at 1516 Hospital Road, Second Floor, Greeley, Colorado. This appointment is scheduled to end at approximately 5:00 p.m. If unable to report as scheduled, you will have two additional work days to report. All appointments for entry into the Welfare Diversion Program are scheduled for 1:15 p.m. You must report no later than 1:15 p.m. or you will be considered late, will not be registered on that day, and will be issued a Rescheduled Appointment Form. Failure to report within the required three days will result in the following: 1. Sanction will be applied if classified as AFDC - Mandatory. Sanction: The needs of the AFDC Head of Household will be deleted when reapplying for AFDC at the Weld County Department of Social Services. 2. If classified as an AFDC - Volunteer, no sanctions will be imposed when reapplying for AFDC. ** Reminder: No children are allowed to attend this appointment. If unable to make arrangement, please telephone Headstart at 356-0600 to arrange for day care for this appointment only. Employee Signature Social Services Eligibility Technician Date White Copy: ESWC Yellow Copy: Employee 870251 21-86-069 Page 6 Attachment B WELFARE DIVERSION REGISTRATION Number AFDC Mandatory _ AFDC Volunteer Section I Employment Services of Weld Household Number SS# County (ESWC) Address Weld County Division of No. of Adults No. of Children Human Resources Applicant: 1516 Hospital Road Potential Grant Amount for Month Diverted P.O. Box 1805 $ Greeley, Colorado 80632 Recipient: Date Diverted Grant Received Month Diverted First Month Grant Amount Not Paid To Whom It May Concern: is being referred to you by the Weld County Department of Social Services to apply for any available employment and/or training under the Welfare Diversion Program. It has been determined that he/she would have been eligible for public assistance if they had not been diverted. Further, it has been determined that he/she is a U.S. Citizen or Work Eligible Non-Citizen. Payments will be made by the State on behalf of the individual or the individual 's household. Would you please verify that he/she has applied by completing this form and returning it to me as soon as possible? Richard Rowe, Employment Counselor Date Weld County Department of Social Services Section II This is to attest to the fact that I have been informed about the Welfare Diversion Program benefits compared to the Social Services AFDC benefits and acknowledge being referred to register in the Welfare Diversion Program. x Signature Date Section III Applicant has been interviewed and is: Enrolled in Job/Program Refused Job/Program Other Signature o mp oyment ec nician Date Registrant's Signature Date Program Start Date White Copy: Welfare Diversion File Yellow Copy: Social Services Pink Copy: Suspense 21-86-332 870251 Page 7 Section IV I understand that it is mandatory that I register for the Welfare Diversion Program and I am required to participate as a condition of eligibility for public assistance. As an AFDC mandatory applicant, I understand that if I refuse or fail to report to the Welfare Diversion Program without good cause, I may only be eligible for financial and medical assistance for the children if the rest of the family is eligible as determined by Social Services. No 30-day waiting period shall be imposed for the first failure to report to the Welfare Diversion Program. For any subsequent refusal or failure to report to Welfare Diversion, a 30-day waiting period, beginning with the date I refuse or fail to report, is required before I can again be considered eligible for AFDC and subsequent referral to Welfare Diversion. No financial or medical assistance is available for my needs as the caretaker relative during the 30 days. The needs of my children shall continue to be covered during that period in accordance with the terms of eligibility. As an AFDC recipient, I understand that if I, without good cause, refuse or fail to participate in the Welfare Diversion Program my needs as the caretaker relative will be deleted from the AFDC Grant if the rest of the family is deemed eligible. No 30-day waiting period shall be imposed for the first refusal or failure to participate in the Welfare Diversion Program. The 30-day wait, beginning with the date I refuse or fail to participate, shall be imposed for any subsequent refusal or failure to participate. The needs of my children shall continue to be covered during that period in accordance with the terms of eligibility. I have been exempted from mandatory participation, but I am volunteering to register and participate in the Welfare Diversion Program. No sanctions will be imposed on AFDC diversion referrals/participants who have volunteered for the Welfare Diversion Program and who are not otherwise mandatory and request to return to AFDC at a later date. x Signature Date x Social Services Designee Date 870251 White Copy: Welfare Diversion File Yellow Copy: Social Services Pink Copy: Suspense Weld Count) Division of Human Resources and social Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-63 Subject: Participation and Termination Procedures Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 8 Walter J. Speckman Social Services shall initiate and complete the application form, explain the program, determine if barriers exist, and determine if the individual is a mandatory referral or exempt from participation in accordance with the selection criteria. The Social Services Technician shall make a written referral to the Welfare Diversion Program by utilizing the Welfare Diversion Registration Form. 1. AFDC Applicants An AFDC applicant classified as a mandatory referral to the Welfare Diversion Program who refuses or fails to report to Employment Services of Weld County shall be issued a PA-75 notification of their ineligibility for Medicaid as a result of their failure to participate in the Welfare Diversion Program. An AFDC applicant classified as a mandatory referral to the Welfare Diversion Program who refuses the referral to Welfare Diversion at the point of AFDC application shall be sent a PA-78 advance notice of action deleting the needs of the caretaker relative if the rest of the family is deemed eligible. A 30-day waiting period, beginning with the date the AFDC applicant refused or failed to report, is required before the individual can again be considered eligible for AFDC or subsequent referral to Welfare Diversion. 2. AFDC Recipient The Social Services Technician shall identify those recipients who may be a mandatory referral . An AFDC mandatory recipient who, without good cause, refuses the referral or fails to participate in the Welfare Diversion Program shall be sent a PA-78 advance notice of action deleting the needs of the caretaker relative if the rest of the family is deemed eligible. No 30-day waiting period shall be imposed for the first refusal or failure to participate in the Welfare Diversion Program. A 30-day waiting period, beginning with the date the AFDC recipient refuses or fails to participate, is required before the individual can again be considered eligible for AFDC or subsequent referral to Welfare Diversion. 870251 Page 9 3. AFDC Volunteers An AFDC applicant/recipient classified as a voluntary referral to the Welfare Diversion Program shall have no sanctions imposed for their failure to participate in the Welfare Diversion Program. No sanctions shall be imposed on AFDC Diversion participants who have volunteered for the Welfare Diversion Program and request to return to AFDC at a later date. AFDC volunteers are defined as single parents with children under 6 months of age. 4. The AFDC Applicant/Recipient The Weld County Department of Social Services shall document in the case record the reason(s) for citing an individual for refusal or failure to report or participate. The name of the recipient shall be added to the list of sanctioned AFDC households. It should be noted that the individual who fails to participate in the Welfare Diversion Program, must reapply for AFDC if they wish to receive a money payment for the children only. 5. Termination Notice The Employment Services of Weld County Employment Technician shall advise the individual and the Weld County Department of Social Services of an individual 's termination in the Welfare Diversion Program by using the Welfare Diversion Program Termination Notice. The Welfare Diversion Program Termination Notice Form shall be completed by Employment Services of Weld County and sent to the Department of Social Services and the individual within three (3) working days of the individual 's termination. (See Attachment A) a. The Welfare Diversion employee's copy (white) of the Welfare Diversion Program Termination Notice will be submitted to the Secretarial Unit prior to 11:00 a.m. daily. The Secretarial Unit will attach a copy of the Complaint Procedures to the Termination Notice and put it in that days outgoing mail (12:30 p.m. daily mail pick up). The Secretarial Unit will use the Welfare Diversion Program Termination Notice Log Form to record the mailing of all terminations (see Attachment B). b. The Employment Technician will place the Social Services' copy (pink) of the Termination Notice in the basket designated for the daily inter-office mail delivery. c. The Employment Services of Weld County's copy (yellow) will be included in the employee's Counseling File. 6. If the Welfare Diversion participant successfully completes the work experience assignment, the employment technician will review the Welfare Diversion Employee Evaluation form to determine if reassignment is warranted. The AFDC participant shall be required to accept a reassignment only twice during a twelve month period. 7. The Welfare Diversion participant may receive up to three (3) contracts (eight (8) weeks in length), but the participant's performance must be evaluated at the end of each contract period prior to re-entry. 870251 Page 10 WELFARE DIVERSION PROGRAM TERMINATION NOTICE EFFECTIVE DATE NAME ADDRESS SSN REASONS) FOR TERMINATION NOTICE a. F--i Unexcused Absence(s) b. FT Failure to call in absence by 8:30 a.m. c. Q Obtained Employment d. I Other (Specify) COMMENTS: Attached is a copy of the Complaint Procedures provided to you on your date of hire. All questions concerning public assistance should be immediately directed to the Department of Social Services. SIGNATURE OF EMPLOYMENT TECHNICIAN SUPERVISOR DATE White Copy: Welfare Diversion Employee Yellow Copy: ESWC Welfare Diversion File Pink Copy: Social Services 870251 21-86-199 Page 11 WELFARE DIVERSION PROGRAM TERMINATION NOTICE Attachment B LOG Effective Date Date of Employment Received Date Name Address Termination Technician Emp. Tech. Mailed • 870251 Weld County division of Human Resources and ...octal Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-64 Subject: Medicaid Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 12 Walter J. Speckman 1. Welfare Diversion Program participants and their eligible family members shall be covered by Medicaid for period of time their Memorandum of Agreement is in effect. Medicaid coverage is not available for the three (3) months retrospective nor the four (4) month extended medical coverage. a. The Intake Unit at Social Services will continue to have responsibility for new applicants and approvals/denials. Once the case is approver-for Medicaid (Title XIX-Only) , it will be routed, after masterfile processing, to the staff member desig- nated to handle the Diversion caseload. b. The staff member at Social Services assigned responsibility for the Welfare Diversion caseload will set up a "tickler file" for recording Medicaid ending date and the specified Primary Physician. Modifications such as address changes, add-a-child, etc. , will be completed, and closure of the case accomplished on a timely basis. c. Application process is unchanged. Diversion participants shall not be referred to the Child Support Enforcement Unit. Any child support efforts will be accomplished under the non-AFDC Program. At the participant's request, Social Services Technicians will provide support enforcement information and/or forms for that program. 870251 Weld County Division of Human Resources and social Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-65 Subject: Day Care Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 13 Walter J. Speckman 1. Welfare Diversion participants may be eligible for day care payments from the Weld County Department of Social Services as specified by the day care regulations. 2. At the time of application for AFDC and referral to the Welfare Diversion Program, the Social Services Technician will thoroughly explain day care provisions. 3. Income Status Day Care (Title XX) is available as long as Title XX guidelines for eligibility are met. The Welfare Diversion income must be 20% higher than day care costs. 4. All Welfare Diversion participants are provided a leave-without-pay day after registration/orientation to take care of child care needs. 5. The Department of Social Services' liaison staff member shall notify the Day Care Unit of all Welfare Diversion terminations in order to stop payment to day care providers. 870251 Weld County division of Human Resources and .,ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C1 Subject: ESWC Initial Application-Taking Procedures Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 1 Walter J. Speckman 1. Reception When the Welfare Diversion Registration form and the Appointment to Report to Work form are received at ESWC, the Registration Unit will verify the status of the applicant in the ES and ESWC terminals. The Receptionist will log in all Welfare Diversion participants by 1:15 p.m. The Receptionist will provide the Introduction sheet (Exhibit A) as soon as the participant is logged in. At 1:15 p.m. the Registration Unit oversees the completion of the registration for Welfare Diversion. If the employee is late, the Receptionist will arrange for another appointment and provide the form, "Notice of Rescheduled Appointment" (Exhibit B) for the participant's signature. 2. Registration a. The Registration staff is responsible for group registration. b. The Registration staff will oversee the participant's completion of the following forms: (1) Application for the Job Training Partnership Act and Job Service (Exhibit C) (2) W-4 Form (Exhibit 0). (3) Release of Information (Exhibit E). (4) Complaint Procedures (Exhibit F). (5) Targeted Jobs Tax Credit Registration (Exhibit G). c. Once all forms are completed, appropriate copies will be given to the employee and the other signed copies will remain with the Registration file. 3. Following the registration, the Welfare Diversion Employment Technician will conduct an orientation on the rules and regulations of the Welfare Diversion Program. 870251 Page 2 EXHIBIT A Welfare Diversion Program Introduction Welcome. You will begin your first introduction into the Welfare Diversion Program today. You should expect to be here from 1:15 p.m. through 5:00 p.m. so you can complete your registration into the pro- gram, obtain a group employee orientation, and complete an Employability Development Plan with us. You will be paid for one hour of your time spent with us today. Please wait in the waiting area until you are called. Thank you. 870251 Page 3 Exhibit B Notice of Rescheduled Appointment Designated appointment time of 1:15 p.m. has been missed. Your next appointment will be on , 19 , at 1:15 p.m. , at the Employment Services of Weld County, Weld County Division of Human Resources, 1516 Hospital Road, Second Floor, Greeley, Colorado. Failure to report within the required three days will result in the following: 1. Sanction will be applied if clasified as AFDC-Mandatory. Sanction: The needs of the AFDC Head of Household will be deleted when reapplying for AFDC at the Weld County Department of Social Services. 2. If classified as an AFDC-Volunteer, no sanctions will be imposed when reapplying for AFDC. Employee Signature • ESWC Designated Representative Date 870251 White Copy - ESWC Yellow Copy - Employee Page 4 d m y _ w .c . 0 w a T N o m d V) 0 ¢ o _ N . d30 d m � 8 W r. o m Ez c o d E �� n; d� m a. ri - I. V w c m °.- ei `o U d o L To o o' of-:II d >.TO1 m 44 /�� 4 W ~ Nm N RI1IIOT r 41 � UVI- JJ Q3 NWww[L u m SQO > O m E ?� m ago ma J t �- vi In tonrotr wp N tl LL o' o o E ' € o, atm N 4 2 c cLLd `- co �Z = o �N V -� d .2 < m O on m m m c CL II>, � 1L — o wmamm > � - z _ � � E O W E E E E u o OM o o o la �pOp � cn L. 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T u W � = E `pm `O ua ° IO w o a a .m. mo o " a CD 00 r yo 00 U _ `m r m r co N LL oa C CO C H m N O d col ° co O O an d O O O d O O LL Z a E A E = E Z .< :It tu To m m Eaa o E (n22 EO o o `m ¢ U m C0. z C Z C 3 d > m o CO to a v O I O o O Ca 2 r- co a g O .!..1- ao 0 IL ^ O to 1 I C = o o W N CO Cr W N CO ICI- IL L_ '1111 n ❑ To C m C .m" C �/ LL C x Qu_ = rQ a I ¢ I 4 CO 0 IA W LL 0 2 - - Y Page 14 CHECK LIST OF SERVICES TO APPLICANT EMPLOYABILITY DEVELOPMENT PLAN SECTION GOALS: �T= PLACEMENT SERVICES Long Range 1. Self selection of jobs 2. Interviewer assistance Short Term 3. Job development 4. Automated job match BARRIERS TO EMPLOYMENT 5. Agricultural placement OTHER AVAILABLE SERVICES 1. Counseling 2. Testing PLANNED STEPS TO REACH GOAL: TIME FRAMES 3. Labor market information 4. Job interview information 5. Veteran benefit information 6. Referral to supportive services 7. Referral to training CHANGES 8. Unemployment insurance 9. Monitor Advocate service The services listed above have been offered to me and I have checked those of interest. I agree to this initial Employability Plan with the understanding that I will be involved in any major changes. APPLICANT'S SIGNATURE DATE APPLICANT% SIGNATURE ESR INITIALS DATE 21-79-256 670251 Page 15 EXHIBIT D W-4 Form The Welfare Diversion Employee should be advised that in completing the W-4 form they can choose one of the following options: 1. list the number of dependents to be claimed or 2. write "Exempt", if they are not planning to claim dependents The Welfare Diversion Employee should follow the instructions on the W-4 Form regarding withholding allowances. The Welfare Diversion Employee should be advised to speak directly to the Internal Revenue Service if they have any questions. 870251 Page 16 mEmoRA(i®U To Welfare Diversion Employees Dare January 74. 1 87 COLORADO From Alvina Derrera, Employment Technician Supervisor Subject: W-4 Form As you are probably aware, a number of changes have been made for the 1987 tax year. You are required to complete a new W-4 Form at this time. If necessary, this information may be changed by completing another W-4 Form. Due to the complexity of the law, the Employment Services Technicians will not answer any questions regarding your withholding allowance. Any questions you may have are to be directed to the Internal Revenue Service at 1-800-424-1040. 870251 Page 17 • Department of the Treasury Step-by-Step Instructions cil @87 i/! internal Revenue Service Step 1—How To Complete Form W-4.— v' First,fill in the information asked for on lines 1 through 3 of the form.Then,if you think Instructions for Form W-4 you might be exempt from withholding,read the instructions for Step 2 2 below.Otherwise, skip to Step 3 on page 2.If you want to have Employee's Withholding Allowance Certificate more money withheld from your pay,see Step 4 on page 2. After your new Form W-4 takes effect,you Why Must I Complete a New Form W-4? should check to see if you are having the The Tax Reform Act of 1986 made many changes to the tax law that could affect want Proper amount withheld.blication919 To do this,My you may to et Pu ,Is your taxes for 1987.Therefore,the amount of tax that is now withheld from your Withholding Correct?For more details on pay may no longer be correct.So that your employer will not withhold too much or withholding,get Publication 505,Tax too little tax from your pay,give your employer a new Form W-4. Withholding and Estimated Tax,and When Must I File the Form? • Publication 553,Highlights of 1986 Tax LawGive your employer a new Form W-4 as soon as possible.While the law requires publications Changes.You in can get these-42 q by calling 1-800-424-FORM you to file a new form before October 1, 1987,you are urged to file early to avoid (3676). incorrect withholding. Note:lf Your Allowances Change.—lf the What Happens If I Do Not Complete the Form? number of withholding allowances you are entitled to claim decreases to fewer than the The amount of tax withheld from your pay may not be close to the amount of tax you will owe whenyou fileyour tax return. Ifyou do notgiveyour employer a new number you a new iW on this 0 ys. you P must file a W4 within 10 days. Form W-4,your employer will have to ignore any previous form you have filed,and Step 2—Are You Exempt From the amount withheld will probably not be correct for your tax situation. Withholding?—You are exempt from How Do I Complete the Form? withholding ONLY if: The following instructions tell you how to complete the Form W-4 on this page. 1. Last year you did not have any Federal Use the worksheet on page 3 to figure the number of withholding allowances you income tax liability;AND can claim on Form W-4. 2. This year you expect to have no Federal income tax liability. Important Change in the Law.—If you Please Note: Most employees will have to complete ONLY lines can be claimed as a dependent on another A through E of the worksheet.But if you have a spouse who is person's tax return(for example,on your also employed,or you have more than one job at the same time, parent's return),you may not be exempt.You or you have nonwage income,complete the rest of the cannot claim exempt status if you have any worksheet.You should also complete the worksheet if you have nonwage income,such as interest on savings, itemized deductions,tax credits,adjustments to income,or the and expect your wages plus this nonwage age or blindness deduction. income to add up to more than$500. If you are exempt,go to line 6 of Form W- 4 and complete the appropriate boxes.Your Should I Claim the Special Withholding Allowance? exempt status will remain in effect until Claim this allowance if you have only one job at a time and you don't have a February 15 of the next year.If you still working spouse.Take this allowance so that you won't have too much tax withheld qualify for exempt status next year, from your pay.See line B of the worksheet on page 3. complete and file a new form by that date. (Continued on page 2) Cut along this line and give this form to your employer.Keep the rest for your records. Form W-4 Employee's Withholding Allowance Certificate OMB No.1545-0010{1087 Department nf the ice ► For Privacy Act and Paperwork Reduction Act Notice,see instructions. u`vf v Internal Revenue Service 1 Type or print your full name 2 Your social security number Home address(number and street or rural route) ❑ Single ❑ Married 3 Marital 0 Married,but withhold at higher Single rate City or town,state,and ZIP code Status Note:If married,but legally separated,or spouse is a nonresident alien,check the Single box. 4 Total number of allowances you are claiming(from the Worksheet on page 3) $ 5 Additional amount,if any,you want deducted from each pay(see Step 4 on page 2) 6 I claim exemption from withholding because(see Step 2 above and check boxes below that apply): a 0 Last year I did not owe any Federal income tax and had a right to a full refund of ALL income tax withheld,AND b ❑ This year I do not expect to owe any Federal income tax and expect to have a right to a full refund of Year ALL income tax withheld.If both a and b apply,enter the year effective and"EXEMPT"here . . . '► 19 c If you entered"EXEMPT"on line 6b,are you a full-time student? ❑Yes ❑No Under penalties of perjury,I certify that I am entitled to the number of withholding allowances claimed on this certificate or,if claiming exemption from-withholding.that I am entitled to claim the exempt status. Employee's signature P. Date ► ,19 7 Employer's name and address(Employer:Complete 7;8,and9 only if sending to IRS) 8 Office 9 Employer identification number code 870251 • Page 18 Form W-4(1987) Page 2 Step 3—Complete the Worksheet on Line G—Itemized Deductions.—Enter the steps to have more tax withheld from your Page 3.—By using this worksheet,the total of the following: pay.You may use the instructions for Step 4 amount of tax withheld from your pay • Medical expenses in excess of 7.5%of to estimate how much additional tax you should closely match your tax liability for your A01• should request your employer to withhold the year. • State and local taxes(exclude sales taxes) each pay period.As an alternative,you may Please claim all the withholding • Home mortgage interest and 65%of use the 1987 Form 1040-ES,Estimated Tax allowances to which you are entitled.In personal interest for Individuals,to make this computation. certain cases,your employer must send • Qualified investment interest Step 4—Additional Amount You Want copies of the Form W-4 to IRS.You may • Charitable contributions Deducted From Each Pay.In some then be asked to verify your allowances. instances,you will be underwithheld,even if This applies if you claim more than 10 • Certain casualty and theft losses in excess you do not claim any withholding allowances withholding allowances,or you claim of 10%of AGI oh Form W-4.This could occur if you have a exemption from withholding under Step 2 • Moving expenses(if reimbursed,include working spouse,more than one job at a time, and your wages are expected to usually only if your employer withheld tax on or nonwage income,AND the number on line exceed$200 a week. them) T of the worksheet is larger than the number Penalty.—You may be fined$500 if,with • Miscellaneous deductions(most of these on line P. no reasonable basis,you file a Form W4 are now deductible only in excess of 2%of To correct this problem,you may have that results in less tax being withheld than is AGI•;see Publication 553) more tax withheld by filling in a dollar properly allowable.In addition,criminal •In general,your AGI(adjusted gross income)is your amount on line 5 of Form W-4.A method of penalties apply for willfully supplying false income less any adjustments to income included on figuring this amount follows: or fraudulent information or failing to supply line F of the worksheet. information requiring an increase in Line J—Additional Standard Deduction 1. Enter the number from line withholding. for Age or Blindness.If you do not T of the worksheet Line B—Special Withholding expect to itemize deductions on your 1987 2. Enter the number from line Allowance.—The Special Withholding age 65 or over or blind, Allowance is very important.Claim it if you3. Subtract line 2 from line 1 .use the following qualify for it,because if you do not,too table. --- - -- --- -- --- - - - .-_. _ much tax may be withheld fromyour 1f 65 or over or If 65 or over 4. Enter the amount from the pay- blind,enter on and blind, table below that applies to$ Claim this allowance if: line J: enter on line J: you • You are single and have only one job at a Single $1,210 $1,960 time;OR Head of Household $2,610 $3360 5. Multiply line 3 by line 4 . • You are married,have only one job at a' Married-Joint $1,840" $2,440•• 6. Divide line 5 by the number time,and your spouse does not work;OR Married-Separate $1,220 $1,820 of pay periods each year. • You have two jobs at a time and only one Qualifying widower) $1,840 $2,440 Enter the result here and on job paid more than$2,500:OR ••If your spouse is 65 or over or blind,add$600 to Form W-4,line 5. . $ • You are married,both you and your spouse this amount.Add$1,200 if spouse is both 65 or over Married Workers' and blind. Combined Annual work,and only one job paid more than $2,500. Line K—Tax Credits.—Enter the amount Income Line Amount Line E—Should I Stop Here?—You may of any tax credits you expect to claim,such under$x,860 $209 $4,860-$29,860 $285 stop here and enter the total from line E on as the credit for child and dependent care $29,861-$46,860 $532 Form W-4,line 4,only if you do not need to expenses,the earned income credit(EIC), $46,861-$91,860 $665 increase or decrease your allowances as and other credits shown on the 1986 Form $91,861 and over $732 explained between lines E and F of the 1040.The amount of the EIC has increased worksheet. for 1987.Get Publication 553 for details. Unmarried Worker's Line F—Adjustments to Income.—Enter Do not include the EIC if you are receiving Annual Income Line 4 Amount j Under$2,440 $209 the total of the following: advance payment of it. g $2440-$17,440 $285 • Qualified reimbursed employee business Line O.—Round the result to the nearest $17,441-$27,640 $532 expenses(unreimbursed expenses are whole number.Dropamounts under.50. $27,641-$54,640 $665 allowed only as an itemized deduction) Increase amounts from.50 to.99 to the $54,641 and over $732 next whole number.For example,3.25 • Qualified alimony payments made • Deductible business and investment losses becomes 3,and 4.61 becomes 5. • Penalty on withdrawal of savings Lines Q through T—Working Spouse? Privacy Act and Paperwork Reduction Act early g More Than One Job?Nonwage Income?— Notice.—We ask for this information to • Qualified contributions to an IRA account So that you will have enough tax withheld, carry out the Internal Revenue laws of the or Keogh plan.If either you or your you MUST complete any lines that apply to United States.We may give the information spouse,if applicable,have an IRA and you. to the Department of Justice for civil or are covered by an employer's pension Line U—Total Withholding Allowances.— criminal litigation and to cities,states,and plan,your 1987 IRA deduction may be If the number on line T is larger than the the District of Columbia for use in reduced or eliminated if your adjusted number on line P,you will probably owe administering their tax laws.You are gross income is at least$40,000 more tax when you file your return and may required to give this information to your ($25,000 if single,or$0 if married filing have to pay a penalty unless you take further employer. separately).Get Publication 590, Individual Retirement Arrangements (IRAs),for details. 870251 Page 19 Form W-4(1987) - page 3 Worksheet To Figure Your Withholding Allowances Note:If you have a working spouse or more than one job at a time, use only one worksheet to figure your total allowances, combining all income,deductions,and credits on the one worksheet. A Enter"1"for yourself unless you can be claimed as a dependent on another person's tax return A • you are single and you have only one job;or B Special Allowance.—Enter"1"if: • you are married,you have only one job,and your spouse does not work;or • wages earned by you on a second job or earned by your spouse(or both) B are$2,500 or less. C Enter"1"for your spouse unless your spouse can be claimed as a dependent on another person's tax return . C D Enter number of dependents other than your spouse that you expect to claim or,your tax return D E Add lines A through D and enter the total"—Read the following instructions to see if you should stop here . . . . ► E You MUST complete lines Q through T if you have total income of$950 or more from the following sources: • A Working Spouse • More Than One Job • Nonwage Income You SHOULD complete lines F through P if you expect to have: • Itemized Deductions • Tax Credits • Adjustments to Income • Age or Blindness Deduction Otherwise,STOP here and enter the number from line Eon Form WA,line 4. n. F Enter your estimated adjustments to Income F $ G Enter your estimated itemized deductions G$ r$3,760 if married filing jointly or qualifying widow(er) 1 H Enter: I. $2,540 if single or head of household H$ $1,880 if married filing separately I Subtract the amount on line H from line G.Enter the result,but not less than zero .• . . I $ J Age 65 or Over? Blind? If you do not plan to itemize deductions, enter your additional standard deduction from instructions for line Jon page 2 J $ K Enter your estimated tax credits,such as child and dependent care credit or earned income credit K$ L If line K is zero, skip to line N. Otherwise, enter the number from the table below I F:,. Married Filing Jointly or Single or Married Filing Head of Household Qualifying Widower) Separately If your combined Enter on If your estimated Enter on If your estimated Enter on estimated wages are— line L wages are— line L wages are— line L At least But less than At least But less than At least But less than $0 $12,500 9 $0 $6,200 9 $0 $8,800 9 $12,500 $37,500 6.5 $6,200 $21,000 6.5 $8,800 $29,000 7 $37,500 $55.000 3.5 $21,000 $31,500 3.5 $29,000 $44,000 4 $55,000 $110,000 3 $31,500 $70,000 3 $44,000 $100,000 3 $110,000 or over 2.5 $70,000 or over 2.5 $100,000 or over 2.5 M Multiply the amount on line K by the number on line L and enter the total amount here . . M $ N Add lines F,I,J,and M.Enter the total amount here N $ O Divide the amount on line N by$1,900.Round to the nearest whole number(see instructions on page 2) . . . . ► 0 P Add lines E and 0 and enter the total number here ► P Q Nonwage Income?—Enter the estimated amount,if any,of all your nonwage income . . Q $ R Working Spouse?More Than One Job?—Too little tax may be withheld if either of these situations applies. See page 4for line R instructions and tables to figure the amount to enter on this line R $ S Add amounts on lines Q and R and enter the total amount here S $ T Divide the amount on line S by$1,900.Round to the nearest whole number(see instructions for line 0) ► T U Total Withholding Allowances.—Subtract the number on line T from the number on line P. 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I also authorize the Weld County Division of Human Resources to supply information to public agencies, non-profit agencies, legal/judicial representatives or systems, financial institutions, and educational facilities, and allow inspection and reproduction of records pertaining to me by a duly authorized representative of the public agencies, non-profit agencies, legal/judicial representatives or systems, financial institutions, and educational facilities. I hereby release all above mentioned parties from any or all liability for supplying such information and waive any and all rights I may have to non disclosure of such records by governmental agencies pursuant to the Colorado Governmental Records Act, Sections 24-72-201, et. seq. , C.R.S. / / Signature of Applicant/Participant Month_ Day— ear gnature o pouse i app ica a Month a>� ear — / / Witness Month 1757—r Copies To: White Copy: Weld County Division of Human Resources Yellow Copy: Participant Signing Release of Information Form 21-87-242 870251 Page 23 EXHIBIT F JTPA Complaint Procedures The two JTPA Complaint Procedure forms are to be read/explained to the participant prior to obtaining their signature. 870251 Training Partnership Act Complaint Pro, ores Pd92 24 Weld County Division of Human Resources P. 0. Box 1805; 1516 Hospital Road Greeley, Colorado 80632 (303) 353-0540 This procedure shall be followed for complaints involving the Job Training Partnership Act, based upon a complaint alleging violation of the rules and regulations of the Job Training Partnership Act, but does not allege a violation based on discrimination. Discrimination complaints other than handicap should be referred to the Office of Civil Rights, U. S. Department of Labor. A problem may be raised with the Department Head of the program involved at any time. The Department Head will make every attempt to resolve the problem. The person raising the problem will be advised of the procedures to follow if the person wants to file a complaint. The Complaint will follow the following procedures in the filing of a complaint: Step 1: The Complainant will file the complaint in writing. The Equal Opportunities/Affirmative Action (EEO/AA) Officer will assist the Complainant in completing the form "Notice of Formal Complaint." The filing of a JTPA complaint shall be made within one (1) year of the alleged occurrence, except those alleging fraud or criminal activity. The EEO/AA Officer will offer a written decision setting forth the findings of fact and give the reasons for the decision within ten (10) calendar days of the formal complaint. The EEO/AA Officer will deliver the written decision to the Complainant, the Department Head, and the Personnel/Client Board. Step 2: Upon receipt of this decision, the Complainant may appeal this decision to the Personnel/Client Board within five (5) calendar days after the receipt of the decision by the EEO/AA Officer. The complaint shall be sent to the attention of the Personnel/Client Board. The Personnel/Client Board will conduct an impartial hearing to review the complaint. The Personnel/Client Board will direct the EEO/AA Officer in the preparation and review of the complete file on the case prior to the hearing. The Personnel/Client Board will: a. Direct parties to appear at the hearing; provide notice of the date, time, and place of the hearing at least five (5) calendar days prior to the hearing; the manner in which it will be conducted; and the stipulated issues to be heard. b. Advise all parties that they are able to be represented by counsel or the representative of their choice; they have the opportunity to bring witnesses and documentary evidence. c. Conduct the hearing in accordance with the attached procedures. d. Question witnesses and parties. e. Consider and evaluate the facts, evidence, and arguments to determine credibility. f. Render a decision. The Personnel/Client Board will give a written decision setting forth the findings of fact and give the reasons for the decision to the Complainant, the Department Head, and the EEO/AA Officer. The written decision will be presented within fifteen (15) calendar days of the date the Complainant filed his or her appeal of the decision of the EEO/AA Officer. Step 3: The Complainant may appeal the final decision of the Personnel/Client Board within ten (10) calendar days. The Chairman of the Personnel/Client Board, the EEO/AA Officer, the Personnel Director, and the legal advisor shall present the case to the Board of County Commissioners for review. The Board may reverse, sustain, or modify the Personnel/Client Board decision. The Board of County Commissioners' final written decision will be made within sixty (60) days of the receipt of a written formal complaint by the EEO/AA Officer in Step 1. All parties shall be notified of the review decision within five (5) calendar days after the review is completed. Step 4: The Complainant may appeal the decision of the County Commissioners within ten (10) calendar days of receipt of the decision to the Governor's Job Training Office. The EEO/AA Officer shall notify the Complainant, in writing, of the appeal process and the address for appeals. NOTE: The identity of all persons who have furnished information relating to a complaint or assisting in the obtaining of facts, shall remain in confidence to the extent possible consistent with a fair determination of the issues. The discrimination Complainants shall be advised of their rights to file their complaints with any other appropriate Federal, State, and local Civil Rights agencies. I have read the above and also had the Job Training Partnership Act Procedures thoroughly explained to me. Signature of Applicant bate Signature of Witness Date White Copy: File ry 21-66-046 Yellow Copy: Applicant fli /0251 Page 25 Job Training Partnership Act Handicap Discrimination Complaint Procedures - Weld County Division of Human Resources P. 0. Box 1805; 1516 Hospital Road Greeley, Colorado 80632 (303) 353-0540 This procedure shall be followed for complaints involving the Job Training Partnership Act, based upon a complaint which alleges that a person was discriminated against because of handicap. A handicap discrimination complaint may be raised with the Department Head of the program involved at any time. The Department Head will make every attempt to resolve the problem. The person raising the problem will be advised of the procedures to follow if the person wants to file a complaint. The Complainant will follow the following procedures in the filing of a complaint: Step 1: The Complainant will file the complaint in writing. The Equal Employment Opportunities/Affirmative Action (EEO/AA) Officer will assist the Complainant in completing the form "Notice of Formal Complaint." The filing of a JTPA handicap discriminatory complaint shall be made within one-hundred eighty (180) calendar days of the alleged occurrence, unless the time for filing has been extended by the Assistant Secretary of the United States Department of Labor. The EEO/AA Officer will inform the Colorado Governor's Job Training Office of the formal filing of the handicap discrimination complaint. The Complaint shall immediately be sent to the attention of the Personnel/Client Board by the EEO/AA Officer. Step 2: The Personnel/Client Board must conduct an impartial hearing to review the handicap discrimination complaint within thirty (30) days of its filing. The impartial Personnel/Client Board will direct the EEO/AA Officer in the preparation and review of a complete file on the case prior to the hearing. The Personnel/Client Board will: a. Direct parties to appear at the hearing; provide notice of the date, time, and place of the hearing at least five (5) calendar days prior to the hearing; the manner in which it will be conducted; and the stipulated issues to be heard. b. Advise all parties that they are able to be represented by counsel or the representative of their choice; they have the opportunity to bring witnesses and documentary evidence. c. Conduct the hearing in accordance with the attached procedures. d. Question witnesses and parties. e. Consider and evaluate the facts, evidence, and arguments to determine credibility. f. Render a decision. The Personnel/Client Board will give a written recommended decision setting forth findings of fact and give the reasons for the decision to the Complainant, the Department Head, and the EEO/AA Officer. The written recommended decision must be presented within forty-five (45) calendar days of the date the Complainant filed his or her handicap discrimination complaint with the EEO/AA Officer. The EEO/AA Officer must then mail the recommended decision to the Governor of the State of Colorado, and such mailing must be postmarked no later than the forty-fifth (45th) day of the filing of the complaint. Step 3: The Governor of the State of Colorado will issue a final decision within sixty (60) days of the date that the Complaint filed his or her handicap discrimination complaint with the EEO/AA Officer. The Governor's final decision will be in writing and will be sent via certified mail to the Complainant and to the Depart- ment Head, the EEO/AA Officer, and the Personnel/Client Board. Step 4: The Complainant may appeal the decision of the Governor of the State of Colorado to the Assistant Secretary of the United States Department of Labor within thirty (30) calendar days of the date of the Governor's decision. The EEO/AA Officer shall notify the Complainant, in writing, of the appeal process and the address for appeals. NOTE: The identity of all persons who have furnished information relating to a complaint or assisting in the obtaining of facts, shall remain in confidence to the extent possible consistent with a fair determination of the issues. The handicap discrimination Complainants shall be advised of their rights to file their complaints with any other appropriate Federal, State, and local Civil Rights agencies. I have read the above and also had the Job Training Partnership Act Handicap Discrimination Complaint Procedures thoroughly explained to me. Signature of Applicant Date Signature of Witness Date White Copy: File Yellow Copy: Applicant 21-86-049/2 870251 Page 26 EXHIBIT G Targeted Jobs Tax Credit Registration Registration should complete the TJTC forms for all Welfare Diversion registrants. A copy of the TJTC Voucher form is to be given to the Welfare Diversion registrant. The TJTC Voucher is valid for a period of 90 days. 870251 Page 27 U.S.DEPARTMENT OF LABOR OMB Approval No. 7205-0058 Employment and Training Administration 1. DATE COMPLETED(Mo.Day, Yr.) Z CONTROL NO.(OPTIONAL) VOUCHER 3. TYPE OF VOUCHER cr one) 4. DATE RECEIVED OR POSTMARKED TARGETED JOBS TAX CREDIT a. O Original b. O Revalidation c. O Letter of Request (State Employment Security Agency's Name and Address) (Participating Agency's Name and Address) Employment Services of Weld County Employment Services of Weld County Weld County Division of Human Resources Weld County Division of Human Resources P.O. Box 1805 P.O. Box 1805 Greeley, Colorado 80632 SIGNATURE(Authorized Official) PHONE NO. (303) 353-0540 PART I. INTRODUCTION HOME PHONE NO. 6. SOCIAL SECURITY NO. 5. NAME OF INDIVIDUAL (Last, First, Middle) MESSAGE PHONE NO. 7. ADDRESS (Number,Street, City,State,ZIP Code) 8. SIGNATURE TO THE EMPLOYER: The above named individual may be eligible for certification under the In the event you hire this person,you should request the certification TARGETED JOBS TAX CREDIT(TJTC)program,as authorized under the necessary for you to claim a TARGETED JOBS TAX CREDIT.Simply com- IRS Code 448. If the person is not employed before (Mo., Day, Yr.),this plete the Employer Declaration below, MAIL TO THE STATE EMPLOY- eligibility is subject to review. MENT SECURITY AGENCY ON OR BEFORE THE DATE ThAT THE APLICANT STARTS WORK,and the Employee TJTC Certification Form will DATE be returned to you. PART II. EMPLOYER DECLARATION I HEREBY DECLARE that the above named person was or will be employed by: 9. NAME OF FIRM 10. EMPLOYMENT STARTING DATE 11. STARTING WAGE (Mo., Day, Yr) $ per hour 12. JOB TITLE OR OCCUPATION Please send a TJTC certification for this employee. The certification is for the purpose of obtaining the benefits of the TARGETED JOBS TAX CREDIT under Section 44B of the Internal Revenue Code. I UNDERSTAND that such credit will cease immediately upon notification of any subsequent invalidation. I FURTHER UNDERSTAND that, if the certification herein requested is for a member of the SUMMER YOUTH target group, the tax credit for which I am eligible for this employee is subject to the limits described at Section 51(d)(12) of the Internal Revenue Code. IN ORDER FOR THE REQUEST FOR CERTIFICATION TO BE VALID: THIS VOUCHER MUST BE MAILED TO THE JOB SERVICE CENTER AND MUST BE POSTMARKED NO LATER THAN THE DAY THE EMPLOYEE STARTS WORK. 13. AUTHORIZED EMPLOYER REPRESENTATIVE b. Title a Name Signature Sic- c. Address(No., St., City,State.ZIP Code) d. Date(Mo.. Day, Yr.) e. Phone No.(Include Area Code) f. IRS Identification No. (As shown on your tax return) NOTE: Falsification of data on this form is a Federal crime in violation of 18 USC 1001. Falsification of work or concealment of information is punishable by a fine of no more than $10,000 or imprisonment of not more than 5 years. 395-72-07-0470 WHITE-APP. CANARY-JSC PINK-JSC(RP1) GOLD-AGENCY ETA 8468(R-May 1984) 870251 Page 28 OMB Approval No. 1205-0058 1. CONTROL NO. (Optional) U.S.DEPARTMENT OF LABOR 2. DATE COMPLETED Employment and Training Administration APPLICANT CHARACTERISTICS TARGETED JOBS TAX CREDIT 3. NAME OF INDIVIDUAL (Last. First. Middle) 4. SOCIAL SECURITY NO. 5. BIRTHDATE (Mo., Day, Yr.) I have determined the eligible individual to have the following characteristics: 6. FAMILY INCOME (Last 6 Months - 7. NUMBER IN FAMILY 8. VETERAN STATUS ("X"One) Annualized) $ N/A ( a. ❑ Veteran b. ❑ Disabled Veteran c. ® Non-Veteran 9. TARGETED GROUP FOR TJTC CERTIFICATION ( X"One Box ONLY) a. ❑ Disadvantaged Youth (18 thru 24) f. ❑ Supplemental Security Income Recipient b. ❑ Disadvantaged Vietnam-Era Veteran g. ❑ General Assistance Recipient c. El Disadvantaged Ex-Convict h. ❑ (DO NOT USE) d. ❑ Vocational Rehabilitation Referral i. ® WIN Registrant/AFDC e. ❑ Youth (16 thru 19) in a Cooperative j. ❑ Disadvantaged Summer Youth Employee (16 thru 17) Ed.Program 10. SOURCES USED TO DOCUMENT ELIGIBILITY(Supplied by Applicant) Welfare indentification verified Weld County Welfare Diversion Program by Rich Rowe, Weld County Department of Social Services. Income excluded because of Welfare. 11. APPLICANTS DECLARATION I CERTIFY that the information I have supplied in completing this form is true and correct to the best of my knowledge. I AGREE that any information I have supplied may be subject to verification. SIGNATURE OF APPLICANT DATE COUNTER SIGNATURE (Parent or Guardian) DATE 12. VOUCHERING AGENCY DECLARATION I have examined the documents and/or contacted the sources indicated in Item 10 and determined that the individual named in Item 3 is eligible. a. VOUCHERING AGENCY NAME AND ADDRESS b. SIGNATURE OF AUTHORIZED OFFICIAL Employment Services of Weld County Weld County Division of Human Resources c. PHONE NO. d.TYPE OF DETERMINATION("X"One) P.O. Box 1805 Greeley, CO 80632 (303) 353-0540 ® Original ❑ Revalidated 13. CERTIFYING AGENCY '14. DATE CERTIFIED 15. AUDIT SAMPLE RESULTS (Complete ONLY if selected as part of random sample in quarterly audit) a. ❑ I have reviewed/contacted the source(s) indicated in Item 10 above and have confirmed that the certified individual is ELIGIBLE. b. El I have reviewed/contacted the source(s) indicated in item 10 above and have determined that the certified individual is INELIGIBLE because: C. ❑ I have not been able to establish that the certified individual is INELIGIBLE because: 870251 16. NAME AND TITLE OF REVIEWER (Must be different than SIGNATURE j� (li FiJDATE person named in Item 12b.) NOTE: Falsification of data on this form is a Federal crime in violation of 18 USG 1001. Falsification of work or concealment of information is punishable by a fine of no more than $10,000 or imprisonment of not more than 5 years. 395-72-07-f14R2 FTA R4R9(R 2/R51 WHITE-JSC(RPT) CANARY-JSC PINK-AGENCY Weld Count, Division of Human Resources and Jocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C2 Subject: AFDC Volunteer Participation in the Welfare Diversion Date: March, 1987 ram Department Pfread Concurrence: Eugene McKenna Page: 29 Walter J. Speckman An AFDC applicant can volunteer for the Welfare Diversion Program once during a twelve (12) month period. This will be measured from the initial volunteer entry date into the Welfare Diversion Program. Exception to this will occur if a volunteer terminates from the Welfare Diversion Program to accept unsubsidized employment and was not terminated for cause from the unsubsidized employment. If this occurs, the AFDC applicant may volunteer one more time. Those AFDC applicants having a partial grant determination of $100 or less, shall not be referred to the Welfare Diversion Program. They will be referred for suitable unsubsidized placement only. Upon completion of an eight week contract, the employment technician will review the mandatory/volunteer status. If the status is changed, the employment technician will requst Social Services to complete a Welfare Diversion Registration to reflect the current mandatory/volunteer status. The client will be informed by the employment technician of their new status and the applicable regulations. 870251 Weld Count) Division of Human Resources and aocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C3 Subject: Orientation Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 30 Walter J. Speckman Employee Orientation includes thorough and careful review of the Welfare Diversion Memorandum of Agreement, Terms and Conditions, W-4 form, and Pre-Employment Health Information Questionnaire. Some of the areas covered are as follows: A. Goals and Objectives of the Welfare Diversion Program B. Worker's Compensation Policy C. Pay Days/Pay Schedule D. Lateness or Absence from Work E. Excused/Unexcused Absences F. Job Search G. Employee Evaluation H. Second Opportunity to Participate in the Welfare Diversion Program I. Sanctions for Failure to Participate The Welfare Diversion Program Memorandum of Agreement (Attachment A) sets the certain work basics for the Welfare Diversion Employee to participate in the program . The Agreement refers to the Welfare Diversion Terms and Conditions (Exhibit A) and the JTPA Complaint Procedures (Exhibit B) , which are a part of the Memorandum of Agreement. The Complaint Procedures of the Job Training Partnership Act (JTPA) apply to Welfare Diversion Program participants. These documents must be thoroughly discussed with the Employee at regis- tration and/or orientation on the Employee's first day of employment. The Weld County Pre-Employment Health Information Questionnaire (Attachment B) must be completed by all Welfare Diversion participants at orientation. This form will be reviewed by the Employment Technician to determine work site assignment. 870251 Page 31 Attachment A Copies to: WELFARE DIVERSION PROGRAM Effective Date: White: MIS File Yellow: Social Services Memorandum of Agreement From: / / Pink: Employee —Fro-7 Dry Thru: / / EMPLOYER: 76715i177-7 Employment Services of Weld County (ESWC) Weld County Division of Human Resources 1516 Hospital Road P.O. Box 1805 Greeley, Colorado 80632 (303) 353-0540 Purpose: The amount, duration, terms and conditions for an agreement of services between the Employee and Employment Services of Weld County (ESWC), are being established to provide Welfare Diversion activities for program eligible ESWC participants. Amendments: This Agreement may be amended at any time with the written consent of all parties. ESWC may issue policies and procedures unilaterally in writing to the Employee to enhance, clarify, or alter the conditions of the Welfare Diversion Program. Wage ESWC agrees to pay the Employee $ 3.35 per hour during the Statement: term of this Agreement. The Employee shall be classified as a temporary, hourly paid Employee during the term of this Agreement. Termination: The Agreement may be immediately terminated by ESWC if federal funds are no longer available to sponsor the program or if the Employee fails to comply with program requirements. Agreement The following exhibits are attached and made a part hereof by reference Exhibit: as fully set forth: Exhibit A, Terms and Conditions; Exhibit B, Complaint Procedures. Agreement This Agreement shall be for the period as outlined above under Duration: Effective Date. WELFARE DIVERSION PROGRAM OUTLINE: 1. Total Hours of Employment per Week: 40 2. The Employment Technician will make the assignment to the work site, based on work availability and physical limitations. 3. Duties may include, but are not limited to, the items listed below: a. Attend required classroom activities for job search. b. Accept referral to jobs, interviews, counseling appointments, and testing. c. Finalize Employability Development Plan with ESWC and complete required actions. 870251 1 /07 • Page 32 Memorandum of Agreement Page 2 - WELFARE DIVERSION PROGRAM OUTLINE: (continued) d. Follow and complete written/verbal procedures and policies provided by ESWC and/or the work site. e. Occupational areas may include but are not limited to: Kennel Attendant, Food Service Worker, Teacher Aide, Cashier, Janitor/Maintenance Worker, File Clerk, Secretary, Receptionist, Production/Assembly Worker, Office Helper, Day Care Attendant, Bus Monitor, Bus Cleaner, Data Entry Clerk, Material Handler, Grounds Keeper, or Community Worker. To perform duties, some physical demands require from sedentary (10 lbs.) to heavy (100 lbs. ) lifting. Also, stooping, kneeling, crouching, and crawling may be required to perform some duties. Physical Limitation Statement/Release of Information Upon review of the "Statement of Work" under the Memorandum of Agreement, I do / do not have any physical limitations which limit my capability of participating in the ATfare Diversion Program. I hereby authorize any hospital or physician to release all information with respect to myself, which will assist in or have a bearing on the assignment to a worksite or the processing of Worker's Compensation claims. Employee Signature Date The Employee and ESWC mutually agree to participate in the Welfare Diversion Program in strict accordance with the terms and conditions herein specified. Further, the parties mutually understand, agree, and acknowledge receipt of all Agreement Exhibits. EMPLOYEE: EMPLOYER: Name Authorized Signature Employment Services of Weld County (ESWC) Weld County Division of Human Resources Address City State Zip Code • Employee Signature bate 870251 Page 33 Exhibit A WELFARE DIVERSION PROGRAM Terms and Conditions A. Employee Classification The Welfare Diversion Employee shall be classified as a temporary, hourly paid Employee during the terms of this Agreement. Employment under the Welfare Diversion Program shall not be deemed as a property right or shall not be deemed as an entitlement to continued employ- ment. B. Employee Wages The Employee shall be employed for a limited period of time on a full-time basis (not less than 40 hours per week) and paid the minimum hourly wage ($3.35). C. Employer Contributions 1. Worker's Compensation All Employees working for the Welfare Diversion Program are covered by Worker's Compensation provided by Weld County. An Employee receiving a job-related disease or injury may be eligible for disability income and medical care. The Employee must follow the procedures as outlined below: a. All injuries, regardless of how minor, that occur during work hours must be reported on the day of the occurrence. b. Employees or witnesses are to report to their supervisors any injuries that occur during work hours and in the course of performing work duties. c. The work site supervisor or Welfare Diversion Employee will immediately call the Division of Human Resources' Employment Services of Weld County at 353-0540 and contact their Employment Technician. d. The Welfare Diversion Employee shall be referred to the physician designated by Weld County to handle Worker's Compensation claims. The claim may be denied if the Employee goes to a private physician. The only exception made will be if the injury is severe enough to require the injured party to be taken to the nearest medical facility by ambulance. e. Payment for chiropractic services will not be made at any time. f. If disability has been determined by the physician, the Employee will be paid a percentage of the normal hourly paid wage from the date of injury. 870251 Page 34 g. Before the injured Employee is allowed to return to work, a written release is required from the physician. h. Failure to follow these established procedures may result in denial of the claim and resulting medical expenses. i . The Employee's Agreement with the Welfare Diversion Program will be immediately terminated if it is determined by Weld County Personnel staff that Worker' s Compensation has been claimed fraudulently. The Weld County Personnel Office will determine if further legal action will be pursued. 2. Social Security Social Security benefits are provided through the equal contribution of Social Security taxes by ESWC and the Welfare Diversion Employee. 3. Insurance Medicaid coverage will be provided only while the Employee is employed with the Welfare Diversion Program. Medicaid questions or concerns must be directed to the Medicaid Division at Social Services. No other health insurance is provided. Life insurance will not be provided while on Diversion. 4. Unpaid Leave Holidays, vacation, or sick leave will not be provided to the Employee. The Employee shall not work for more than 40 hours per week. Compensatory time and overtime or payment for such shall not be provided to the Employee. Time lost due to illness, tardiness, doctor appointments, emergency time, court time, etc. may not be made up. 5. Salary and Merit Increases Salary or merit increases will not be provided during the term of this Agreement. 6. Reimbursable Expenses The Employee shall not be paid for mileage, parking fees, meals, lodging or other expenses associated with this Agreement. D. Employee Time Sheet The Employment Technicians are responsible for submitting the number of hours worked by the Welfare Diversion Employee. Prior to signing the wage verification documents, it is the Employee's responsibility to verify that the hours being paid for are accurate. E. Employee Work Week and Hours The work week shall consist of 40 hours per week, not including a scheduled lunch period. A lunch period must be taken daily. 8'70251 Pane 35 The designated Employment Technician must be notified no later than 8:30 a.m. , if the Employee anticipates being late or absent from work. Absences or tardiness following a scheduled lunch period must be reported within thirty minutes from start time. If the Employment Services of Weld County (ESWC) is closed on the day of an absence, the Employee will be required to report the absence by 8:30 a.m. the next work day. If this procedure is not followed, the time missed will be treated as an unexcused absence and result in immediate termination of the employee's Memorandum of Agreement. The Employee must notify an Employment Technician in the Welfare Diversion Unit prior to leaving the work site for any reason. F. Employee Pay Day Pay days will be on the 15th and the last working day of each month. Pay dates falling on weekends will be scheduled for the Friday prior to the weekend. Checks will be distributed at Employment Services of Weld County, 1516 Hospital Road, 2nd floor, Greeley, Colorado, between 4:00 p.m. and 5:00 p.m. , and at the Fort Lupton Office by appointment. Checks will not be distributed prior to this time without the expressed authorization of the Employment Services of Weld County Director or designee. If the Employee misses work on the day scheduled for pay day, the check cannot be released until the next scheduled work day. G. Deductions from Pay Social Security taxes are automatically withheld from the Employee's paycheck. Deduction from the Employee's paycheck shall be made if ESWC is served with a court order garnishment. Federal and/or state taxes will not be withheld if the Employee signs a W-4 form claiming exemption. H. Notice of Resignation The Employee shall notify ESWC, in writing, as soon as possible of the Employee's intent to resign. The Employee shall state the reason(s) for resignation, and give no less than two weeks notice before resigning. If an unsubsidized job is obtained, immediate resignation is acceptable. If the reason for resignation is other than for a job placement, the Employee Sanction Clause will be evoked (Item K). I. Excused Absences * For purposes of this section, immediate family will include: Employee's husband, wife, son, daughter, step-son, step-daughter, father, mother, step-father, step-mother, brother, sister, father-in-law, mother-in-law, grandmother, grandfather, grandchild, foster child, foster parent, or any other person sharing the relationship of in loco parentis. (An uncle, aunt, nephew, niece, cousin, brother-in-law and sister-in-law not sharing the relationship of in loco parentis are not defined as immediate family. ) 1. Leave Without Pay The Employee is provided a day of leave-without-pay when beginning the Welfare Diversion Program to file for Unemployment Insurance, arrange for child care and transportation, or take care of any other related work problems. On the scheduled day of leave-without-pay, the Department of 870251 Page 36 Social Services has set aside time from 1:00 p.m. to 2:00 p.m. to enroll and provide the Welfare Diversion Employee with day care assistance. The Employment Technician(s) will take into consideration the existing conditions and notify the Employee of the excused leave-without-pay prior to the leave being taken. Jury Duty Jury duty will be excused if the Employee presents the jury duty documents to the Employment Technician prior to the time jury duty will start. Jury duty time will be considered as leave-without-pay, and will not count against excused absences. Food Stamps Food stamp appointments for AFDC households will be considered as leave-without-pay and will not be counted against excused emergency time. The Employee is required to notify the Employment Technician prior to the food stamp appointment; food stamp appointments will be verified by the Employment Technician prior to the scheduled time. If the food stamp appointment is for an AFDC-I (incapacitated) household, the non-working spouse will be required to keep the food stamp appointment. Rescheduling the allotted lunch period for a food stamp appointment will be allowed when the Employee has made prior arrangements with the work site supervisor. An Employment Technician must be notified of this arrangement prior to leaving the work site. Any time exceeding the allotted lunch hour will be docked from the Employee's pay. Children's School Registration Children's school registration will also be considered leave-without-pay and will not be counted against excused emergency day. Inclement Weather If it is determined by the Employment Technician that the Employee is unable to attend work due to inclement weather, leave-without-pay will be applied to the time missed. The Employee will be required to call in the absence. 2. Sick Day Absence During each eight (8) week period, the Employee will be allowed a total of two (2) sick days (unless as outlined below). These sick days may be for a scheduled doctor's appointment, in which case the Employment Technician must be notified 48 hours in advance, or for an emergency sick day, in which case the Employment Technician must be notified no later than 8:30 a.m. on the day the absence will occur. One additional day for sick leave may be allowed if the Employee or a member of the immediate family has a serious illness. Failure to follow these procedures will result in immediate termination of the Employee's Memorandum of Agreement. Examples of Absences If the Employee or an immediate family member is sick for three (3) consecutive days, a physician's excuse for the days missed is required. 870251 Page 37 The Employment Technician must be notified no later than 8:30 a.m. on each d� the absence will occur. Failure to follow these procedures will result in immediate termination of the Employee's Memorandum of Agreement. The Employee will have no sick time left. If the Employee is sick one (1) day and later within an eight (8) week period the Employee or an immediate family member is sick two (2) days in a row, a doctor's excuse must be presented to be an excused absence. Again, the Employment Technician must be notified no later than 8:30 a.m. on each day the absence will occur. The Employee will have no sick time left. 3. Court Absence During an eight (8) week period, the Employee shall be allowed a total of one (1) court day. The court appearance must have the prior approval of the Employment Technician. Total court absences shall not exceed eight (8) hours per eight (8) week period. 4. Emergency Absence During an eight (8) week period, the Employee shall be allowed one (1) emergency day. The Employment Technician may provide emergency leave for the following reasons: (a) major transportation problems (this applies only to those Employees living in areas outside of the Greeley Bus System), (b) child care problems, (c) eviction from housing, (d) to attend a funeral of a member of the Employee's immediate family. All emergency leave must be approved by an Employment Technician. If a member of an AFDC-I household has a problem with child care, or is being evicted from their home, the non-working spouse will be required to take care of the problem. Funeral Leave The Employee may be granted up to two (2) additional days to attend the funeral of the Employee's immediate family. Prior approval must be obtained from an Employment Technician prior to 8:30 a.m. on the day the emergency leave is requested. 5. Jailed or Incarcerated If jailed or incarcerated, the time spent will exhaust excused days in the following order: IN JAIL TIME EXCUSED ABSENCE SEQUENCE First Day One (1) court day (if not previously used) Second Day One (1) emergency day (if not previously used) Third Day One (1) sick day (if not previously used) Forth Day One (1) sick day (if not previously used) Fifth Day and Over Leave without pay If all excused time is exhausted while incarcerated, no other time off will be allowed during an eight (8) week period. 870251 Page 38 J. Reasons for termination of Memorandum of Agreement Causes for dismissal may include: unexcused absence, continual tardiness, refusal to go out to a job referral , failure to show for work or call if late, failure to keep an interview appointment, lack of participation in the job outlined in the Agreement, leaving the work site without Employment Technician's authorization, and failure to attend a workshop or class without expressed authorization of an Employment Technician. The Employee agrees to make the proper arrangements for transportation and child care related problems. All reasons not documented in Item I will be considered unexcused absences. An unexcused absence will result in immediate termination of the Employee's Memorandum of Agreement. K. Employee Sanction Clause On referral to the Welfare Diversion Program participants are classified as: (a) Aid to Families with Dependent Children (AFDC) Mandatory (children are 6 months or older) (b) Aid to Families with Dependent Children (AFDC) Volunteer (children are under 6 months) 1. A Welfare Diversion Employee whose Memorandum of Agreement has been terminated shall be granted a second opportunity to return to the program. The Employee must attend an orientation within 3 working days from the date of the termination. Contact must be made with Rich Rowe at 352-1551 or an Employment Technician at 353-0540, to arrange an orientation time. If the second chance orientation is not attended within 3 working days, the second opportunity will be automatically exhausted and applicable sanctions will apply. a. If classified as AFDC Mandatory and Memorandum of Agreement has been terminated as outlined in Item H, I, and J, the following sanctions will apply: When application for public assistance is made at the Weld County Department of Social Services and the household is deemed eligible, the needs of the head of household will be deleted from the grant. This sanction will remain for 30 days from the date of termination from the Welfare Diversion Program and will be imposed for any refusal or failure to participate in the Welfare Diversion Program. b. If classified as AFDC Volunteer and Memorandum of Agreement has been terminated for cause, no sanction will apply when application is made for public assistance at the Weld County Department of Social Services. However, re-entry into the Welfare Diversion Program will not be allowed for a period of twelve (12) months from the date of termination. c. If an Employee's On-the-Job Training Contract (O.J.T. ) has been terminated for cause, or if an employee quits an O.J.T. position, the sanction will apply. If the second chance opportunity has not been taken, the Employee will return to Welfare Diversion. If the Employee terminates an O.J.T. , they will not be considered for future O.J.T. positions. 870251 Page 39 3. An AFDC Volunteer whose Memorandum of Agreement has been terminated for the fina t1 time Tom the Welfare Diversion Program, must enter a twelve (12) month waiting period prior to re-entry into the Welfare Diversion Program. Exception to this will be for the AFDC Volunteer who finds unsubsidized employment and whose Memorandum of Agreement was not terminated for cause from the unsubsidized employment. In this case, the Employee will have one (1) additional volunteer entry into the Welfare Diversion Program. 4. The Employee must remain eligible for Aid to Families with Dependent Children (AFDC) throughout the term of the Memorandum of Agreement. If ineligibility is determined by Social Services, an Employment Technician will give notice informing the Employee of the Welfare Diversion Program Memorandum of Agreement termination date. L. Job Search Policy It is important to remind the Employee that the Welfare Diversion Program offers temporary employment. The goal of the program is to work toward obtaining full-time, unsubsidized, permanent employment. An important part of the Welfare Diversion Program is the Job Search Class. The Job Search activities include classes on job safety, interviewing techniques, resume composition, application completion, labor market information, and other job seeking, job obtaining, and job retention skills. The Employee will be required to attend and complete these scheduled classes. The Welfare Diversion Employee will be required to work with an Employment Technician on an individual basis on an employability development plan. This will ensure the Employee is seeking the proper job contacts. The work site supervisor's role is to assist with the development of the Employee's job retention skills. The Employee will be required to attend safety orientations, participate in employee performance evaluations, adhere to work site operational procedures, and meet work site expectations for appearance, dress, and behavior. The Employee will be required to take care of personal problems away from work so they do not interfere with the job. An Employee's active role in job search is essential if it is to be successful . This not only includes participation in structured activities, but individual efforts which include the following: making allowable job contacts during participation in Welfare Diversion, seeking employment through the Job Service, reviewing want ads, talking to neighbors and friends regarding possible jobs, going to job referrals made by the Employment Technician, participating in job development activities, and filling out applications. The Employee may actively seek unsubsidized employment by arranging interviews after obtaining the Employment Technician's prior approval . The Employee must provide the name, address, and telephone number of the interviewer/employer. The Employment Technician must approve the interviewer/employer contact before the Employee may leave the work site. Failure to obtain prior approval to leave the work site for an interview/employer contact will constitute an unexcused absence. The Employee's Memorandum of Agreement will be terminated if the Employee leaves the work site to attend the non-approved interview/employer contact. 870251 Page 40 Time missed from work for an approved referral to a job or job search activities will be paid at the regular rate of $3.35 per hour. M. Review and Assignment Prior to the end of each Welfare Diversion Agreement, the Employee will be reviewed for re-entry into the Welfare Diversion Program based on the Welfare Diversion Employee Evaluation that will be completed by the worksite supervisor. The Employment Technician has the discretion to grant a new eight (8) week agreement, or refer the Employee to Social Services for a public assistance grant based on employment barriers. The Employee may receive up to three (3) consecutive Welfare Diversion agreements of eight (8) weeks in length. The Employee's performance must be reviewed prior to the end of each Memorandum of Agreement period for re-entry. Upon completion of the third eight (8) week contract, AFDC households may be eligible for re-entry into the Welfare Diversion Program at the end of one year from the date of termination. To be considered for O.J.T. programs, the Employee must successfully complete, at a minimum, six (6) weeks of an eight (8) week agreement, and have the aptitude and basic requirements needed for training. Upon completion of an eight week contract, the Employment Technician will review th mandatorty/volunteer status. If the status is changed, the Employment Technician will request the Social Services complete a Welfare Diversion Registration to reflect the current mandatory/volunteer status. Thje client will be informed by the Employment Technician of their new status and the applicable regulations. 870251 Page 41 Statement of Acknowledgement During the Welfare Diversion orientation, was assigned as my Employment Technician. The Welfare Diversion Terms and Conditions were read and explained. I acknowledge receiving and understanding all items contained in the Welfare Diversion Terms and Conditions, specifically the regulations on the following: Worker's Compensation, lateness or absence from work, day care information, employee pay days, excused/unexcused absences, employee evaluations, job search, chance for a second opportunity, reasons for termination, and application of sanctions. Employee Signature Date Witness Date 870251 Page 42 SECOND OPPORTUNITY TO PARTICIPATE IN THE WELFARE DIVERSION PROGRAM I , understand that I am being offered a second chance to participate in the Welfare Diversion Program. I further understand that I must re-enter the Welfare Diversion Program within three days from termination of the Memorandum of Agreement. I also understand that if I do not return within three days, the only financial assistance will be AFDC for my children. My appointment time to re-enter the Welfare Diversion Program is: on , at the Time Date Department of Human Resources, located at 1516 Hospital Road, Greeley, Colorado. Client's Signature Date Social Services' or Human Resources' Date Representative's Signature 870251 Page 43 Job Training Partnership Act Complaint Proc "es Exhibit B Weld County Division of Human Resources P. 0. Box 1805; 1516 Hospital Road • Greeley, Colorado 80632 (303) 353-0540 This procedure shall be followed for complaints involving the Job Training Partnership Act, based upon a complaint alleging violation of the rules and regulations of the Job Training Partnership Act, but does not allege a violation based on discrimination. Discrimination complaints other than handicap should be referred to the Office of Civil Rights, U. S. Department of Labor. A problem may be raised with the Department Head of the program involved at any time. The Department Head will make every attempt to resolve the problem. The person raising the problem will be advised of the procedures to follow if the person wants to file a complaint. The Complaint will follow the following procedures in the filing of a complaint: Step 1: The Complainant will file the complaint in writing. The Equal Opportunities/Affirmative Action (EEO/M) Officer will assist the Complainant in completing the form "Notice of Formal Complaint." The filing of a JTPA complaint shall be made within one (1) year of the alleged occurrence, except those alleging fraud or criminal activity. The EEO/M Officer will offer a written decision setting forth the findings of fact and give the reasons for the decision within ten (10) calendar days of the formal complaint. The EEO/AA Officer will deliver the written decision to the Complainant, the Department Head, and the Personnel/Client Board. Step 2: Upon receipt of this decision, the Complainant may appeal this decision to the Personnel/Client Board within five (5) calendar days after the receipt of the decision by the EEO/M Officer. The complaint shall be sent to the attention of the Personnel/Client Board. The Personnel/Client Board will conduct an impartial hearing to review the complaint. The Personnel/Client Board will direct the EEO/AA Officer in the preparation and review of the complete file on the case prior to the hearing. The Personnel/Client Board will: a. Direct parties to appear at the hearing; provide notice of the date, time, and place of the hearing at least five (5) calendar days prior to the hearing; the manner in which it will be conducted; and the stipulated issues to be heard. b. Advise all parties that they are able to be represented by counsel or the representative of their choice; they have the opportunity to bring witnesses and documentary evidence. c. Conduct the hearing in accordance with the attached procedures. d. Question witnesses and parties. e. Consider and evaluate the facts, evidence, and arguments to determine credibility. f. Render a decision. The Personnel/Client Board will give a written decision setting forth the findings of fact and give the • reasons for the decision to the Complainant, the Department Head, and the EEO/M Officer. The written decision will be presented within fifteen (15) calendar days of the date the Complainant filed his or her appeal of the decision of the EEO/M Officer. Step 3: The Complainant may appeal the final decision of the Personnel/Client Board within ten (10) calendar days. The Chairman of the Personnel/Client Board, the EEO/AA Officer, the Personnel Director, and the legal advisor mm shall present the case to the Board of County Commissioners ?or review. The Board may reverse, sustain, or modify the Personnel/Client Board decision. The Board of County Commissioners' final written decision will be made within sixty (60) days of the receipt of a written formal complaint by the EEO/AA Officer in Step 1. All parties shall be notified of the review decision within five (5) calendar days after the review is completed. Step 4: The Complainant may appeal the decision of the County Commissioners within ten (10) calendar days of receipt of the decision to the Governor's Job Training Office. The EEO/AA Officer shall notify the Complainant, in writing, of the appeal process and the address for appeals. NOTE: The identity of all persons who have furnished information relating to a complaint or assisting in the obtaining of facts, shall remain in confidence to the extent possible consistent with a fair determination of the issues. The discrimination Complainants shall be advised of their rights to file their complaints with any other appropriate Federal, State, and local Civil Rights agencies. I have read the above and also had the Job Training Partnership Act Procedures thoroughly explained to me. Signature of Applicant Oate signature of Witness Date White Copy: File Yellow Copy: Applicant 21-86-046 870251 Page 44 Job Training Partnership Act Exhibit B Handicap Discrimination Complaint Procedures Weld County Division of Human Resources P. 0. Box 1805; 1516 Hospital Road Greeley, Colorado 80632 (303) 353-0540 This procedure shall be followed for complaints involving the Job Training Partnership Act, based upon a complaint which alleges that a person was discriminated against because of handicap. A handicap discrimination complaint may be raised with the Department Head of the program involved at any time. The Department Head will make every attempt to resolve the problem. The person raising the problem will be advised of the procedures to follow if the person wants to file a complaint. The Complainant will follow the following procedures in the filing of a complaint: Step 1: The Complainant will file the complaint in writing. The Equal Employment Opportunities/Affirmative Action (EEO/AA) Officer will assist the Complainant in completing the form "Notice of Formal Complaint." The filing of a JTPA handicap discriminatory complaint shall be made within one-hundred eighty (180) calendar days of the alleged occurrence, unless the time for filing has been extended by the Assistant Secretary of the United States Department of Labor. The EEO/AA Officer will inform the Colorado Governor's Job Training Office of the formal filing of the handicap discrimination complaint. The Complaint shall immediately be sent to the attention of the Personnel/Client Board by the EEO/M Officer. Step 2: The Personnel/Client Board must conduct an impartial hearing to review the handicap discrimination complaint within thirty (30) days of its filing. The impartial Personnel/Client Board will direct the EEO/AA Officer in the preparation and review of a complete file on the case prior to the hearing. The Personnel/Client Board will: a. Direct parties to appear at the hearing; provide notice of the date, time, and place of the hearing at least five (5) calendar days prior to the hearing; the manner in which it will be conducted; and the stipulated issues to be heard. b. Advise all parties that they are able to be represented by counsel or the representative of their choice; they have the opportunity to bring witnesses and documentary evidence. c. Conduct the hearing in accordance with the attached procedures. d. Question witnesses and parties. e. Consider and evaluate the facts, evidence, and arguments to determine credibility. f. Render a decision. The Personnel/Client Board will give a written recommended decision setting forth findings of fact and give the reasons for the decision to the Complainant, the Department Head, and the EEO/AA Officer. The written recommended decision must be presented within forty-five (45) calendar days of the date the Complainant filed his or her handicap discrimination complaint with the EEO/M Officer. The EEO/AA Officer must then mail the recommended decision to the Governor of the State of Colorado, and such mailing must be postmarked no later than the forty-fifth (45th) day of the filing of the complaint. Step 3: The Governor of the State of Colorado will issue a final decision within sixty (60) days of the date that the Complaint filed his or her handicap discrimination complaint with the EEO/AA Officer. The Governor's final decision will be in writing and will be sent via certified mail to the Complainant and to the Depart- ment Head, the EEO/AA Officer, and the Personnel/Client Board. Step 4: The Complainant may appeal the decision of the Governor of the State of Colorado to the Assistant Secretary of the United States Department of Labor within thirty (30) calendar days of the date of the Governor's decision. The EEO/M Officer shall notify the Complainant, in writing, of the appeal process and the address for appeals. rmatio relating to a plaint r NOTE: btainingi of facts,all persons remain in have furnished hto the oextentn possible consistent with aofai assisting The identty of fair determination of the issues. The handicap discrimination Complainants shall be advised of their rights to file their complaints with any other appropriate Federal, State, and local Civil Rights agencies. I have read the above and also had the Job Training Partnership Act Handicap Discrimination Complaint Procedures thoroughly explained to me. bate Signature of Applicant Date 'Signature of Witness White Copy: File Yellow Copy: Applicant 21-86-049/2 870251 Page 45 • WELD COUNTY Attachment B PREEMPLJYMENT HEALTH INFORMATION GUESTIONAIRE HEIGHT NAME WEIGHT To the best of your knowledge and belief , have you now or ever had or been treated for any of the following? (check yes or no) YES : NO 1 . any impairment of vision? • wear glasses or contacts? 2.any impairment of hearing? wear hearing aide? _ . any fractures of bones? 4. loss of fingers, toes, foot , hand or leg? 5.mental condition? 6.addiction to drugs or alchohol? . ; 7.heart disease? B.hernia? 9.diabetes? • ; 1O.pain in the back? : ll. fainting 'spells or seizures? 12.hepatitus? If you have answered yes to any of the above questions, give complete details. Describe problem. Give your age at the time of the problem, name of the doctor and/or hospital where treated and current status regarding that problem. - • • I certify that the above statements are true, full and complete to the best of my knowledge. SIGNATURE DATE 870251 Weld Count, Jivision of Human Resources and aocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C4 Subject: Leave-Without-Pay Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 46 Walter J. Speckman The following f be considered by the Employment Technician as time allowed for leave-without-pay: 1. Arranging for day care and transportation on the day after registration/orientation into the Welfare Diversion Program 2. Jury duty 3. Food Stamp appointments 4. Enrolling children in school 5. Delivering sick children to the alternate day care provider 6. Inclement weather 7. Extended emergency days (2) for death in immediate family 8. Extended emergency days for serious illness illness to employee or a dependent of the employee The employment technician(s) will take into consideration the existing conditions and notify the employee of the excused leave-without-pay prior to the leave being taken. 870251 Weld Count, Division of Human Resources ano social Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-05 Subject: Employability Development Plan Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 47 Walter J. Speckman The Welfare Diversion Employability Development Plan is an assessment of an individual 's work skills, barriers to employment, and short and long term employment goals. Each time the Employee is considered for re-entry or continuation of the Welfare Diversion Program, the plan will be reviewed for an update. 870251 Page 48 Welfare Diversion Program ri Hand. Employability Development Plan Int. Date n Vol. - Update Employee: Address: F--1 Review Street City State Zip Phone: DOB: SS No.: 11IIIIIIf Family Composition: (name & birthdate) YOU MAY CONTACT THE FOLLOWING STAFF MEMBER IF YOU HAVE A COMPLAINT OR GRIEVANCE OR NEED FURTHER INFORMATION: - 353-0540 Short Term Goals Long Term Goals Daycare: Yes No _ ( Contract) From: To: Site: Position: Education/Work Experience/Skills: Services Needed/Provided Employee Signature Date Employment Technician Signature Date Evaluation Results: SUCCESSFUL COMPLETION: Yes _ No Are you willing to relocate? Yes _ No — Transportation: Yes _ No _ Type � Employment Barriers Identifed Referring back to Social Services because of employment barriers. (See Employment Barriers) Employment Technician Signature Date Employee Signature Date 870251. , Page 2 Page 49 ( Contract) From: To: ( Contract) From: To: Site: Position: Site: Position: Services Needed/Provided Services Needed/Provided Employee Signature Date Employee Signature Date Employment Technician Signature Date Employment Technician Signature Date Evaluation Results: Evaluation Results: SUCCESSFUL COMPLETION: Yes No SUCCESSFUL COMPLETION: Yes No ( Contract) From: To: ( Contract) From: To: Site: Position: Site: Position: Services Needed/Provided Services Needed/Provided Employee Signature Date Employee Signature Date Employment Technician Signature Date Employment Technician Signature Date Evaluation Results: Evaluation Results: SUCCESSFUL COMPLETION: Yes No SUCCESSFUL COMPLETION: Yes No 870251 Weld Counts Jivision of Human Resources ano .ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C6 Subject: Medical Evaluations Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 50 Walter J. Speckman The procedure to obtain a medical evaluation is as follows: 1. Normal procedures of referral will be made by Social Services to the Welfare Diversion Program. 2. The applicant will complete the intake procedures, complete and sign the Welfare Diversion Memorandum of Agreement, and complete and sign the Weld County Pre-Employment Health Information Questionnaire. 3. The Employment Technicians will review the Weld County Pre-Employment Health Information Questionnaire to determine if a medical evaluation is necessary. a. On determination that a medical evaluation is required, the designated Employment Technician will inform Social Services that a medical evaluation is necessary by using the form "Applicants Requiring Medical Evaluations" (Attachment A). b. The Pre-Employment Health Information Questionnaire (Attachment B) will then be given to the Secretarial Unit for transmittal to Weld County Personnel . The form entitled "Transmittal of Completed Pre Employment Health Information Questionnaire" (Attachment C) will be used to identify which clients were determined to need a medical evaluation. The Weld County Personnel Department will note their receipt of the forms and return the transmittal form indicating any action items/steps needed to be accomplished by ESWC. Personnel will retain all originals of the Pre-Employment Health Information Questionnaire at their office. c. Social Services will contact the designated Social Services physician, schedule an appointment for the applicant, and return the appointment forms to ESWC. The Employment Technicians will advise the client of his/her scheduled medical appointment and allow the time for him/her to arrive at the scheduled appointment 15 minutes early. The client will sign the form "Medical Appointment Statement" (Attachment D). If the client can not be reached to be informed about the scheduled appointment, the Employment Technician will advise Social Services. Social Services may cancel the appointment, reschedule the appointment, etc. 870251 Page 51 d. Social Services will receive a medical determination within a 'ten (10) day period. The medical information is to be relayed directly to the Personnel Department and to the Employment Technicians. The Personnel Department will notify the Employment Technician if special consideration must be given when selecting a worksite for the client. 4. ESWC will not retain a copy of the Weld County Pre-Employment Health Information Questionnaire form within the participant's file. All originals will be forwarded to the Personnel Department. 5. Any unresolved questions arising regarding the usage of the Health Questionnaire form (by agencies or applicants) will be referred to the Personnel Department and such inquiries noted to the ESWC Director. s 870251 Attachment A Page 52 ThEMORAI1DU WII'Dc To Rich Rowe, Department ofDate Social Services COLORADO FromWelfare Diversion Program, Employment Services of Weld County subject: Applicants Requiring Medical Evaluations 1. 2. 3. 4. 5. 6. 7. E. 9. 10. 11. 12. 870251 WELD COUNTY Attachment B Page 53 PREEMPLOYMENT HEALTH INFORMATION GUESTIOUAIRE NAME HEIGHT • WEIGHT To the best of your knowledge and belief , have you now or ever had or been treated for any of the following? (check yes or no) 1 . any impairment of vision? YES 1 NO wear glasses or contacts? 2. any impairment of hearing? wear hearing aide? • 3. any fractures of bones? • 4. 1oss of fingers, toes, foot , hand or leg? ; 5.mental condition? 6. addiction to drugs or alchohol? . , 7.heart disease? 2 8.hernia? • 9. diabetes? lCLpain in the back? ' il. fainting spells or seizure≤? 12. hepatitus? ' • If you have answered yes to any of the above questions, give complete details. Describe problem. Give your age at the time of the problem, name of the doctor and/or hospital where treated and current status regarding that problem. - • • ---------I certify that the above statements are true, full and complete to the best of my knowledge. SIGNATURE DATE 870251 Attachment C Page 54 -mEMORAnDUM WIDeTo Weld County Personnel Department Date COLORADO From Employment Services of Weld County, Human Resources Subject Transmittal of Completed Pre-Employment Health Information Questionnaire Please complete the follwing information and return this transmittal note to Employment Services of Weld County (ESWC) on the succeeding day. Completed Weld County Pre-Employment Health Information Questionnaire: * Identified by ESWC staff for medical evaluation Name Social Security Number 1. 2. 3. 4. 5. 6. 7. 8. I am in receipt of the above completed forms: Signature of Authorized Personnel Staff bate Note any action items/steps needed by ESWC: 870251 Attachment D Page 55 Medical Appointment Statement ' Your appointment for a medical evaluation is scheduled as follows: Client's Name Date time Physicians Name Address I hereby acknowledge the receipt of my appointment information. I understand that if I do not keep the appointment I may be charged for the cost of the appointment through a deduction from my Welfare Diversion check. If I am unable to arrive on time or keep (attend) my appointment, I agree to inform prior to the appointment. Signature Date White Copy: Welfare Diversion File Yellow Copy: Employee/Participant 1/87 870251 21-86-161 Weld Counts Division of Human Resources and ..ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C7 Subject: Payroll Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 56 Walter J. Speckman 1. The Welfare Diversion Employee is paid $3.35 per hour. Payment will be received for one (1) hour of orientation and for each hour worked subsequently. The payroll process is outlined in Attachment A; and the payroll schedule is outlined in Attachment B. 2. On the following holidays, the Welfare Diversion Employee will not be required to work nor will they receive pay: a. New Year's Day b. Memorial Day c. Labor Day d. Thanksgiving Day e. Christmas Day On all other holidays, the client will either work or attend a workshop in order to ensure payment of wages for that day. 870251 Page 57 Attachment A Payroll Process Referred by Social Services Registration/Orientation Daily Client Orientation List Individual Client W-4's to Fiscal New Employee Start-up or Info. Input F— Sent to <E— Re-hire Processed in Payroll County System Accounting Two Days Prior to Pay Date Employment Technicians Call Work Sites for Hours Worked by Client W Hours Put on Client's Time Sheets Time Sheets Turned in to Fiscal 1 Fiscal Technician Verifies Hours Hours Input into County Warrant ( Payroll System Issued Fiscal Technician Picks up Checks 4 Client Technician Verifies Checks with Time Sheets Checks Passed out by Technicians 870251 Attachment B Page 58 iiiikestlie -. mEmoRAnDum WilkTo All Welfare Diversion Employees Date January 6, 1987 COLORADO Fram Alvina Derrera, Welfare Diversion Unit Supervisor Op- Payroll Regulations Subject: To be paid on the scheduled payday, the Welfare Diversion Employee must work certain days prior to payday. This is necessary since the pay is up-to-date. The Employee shall not miss work on payday. If work is missed during this time, the employee must wait until the first work day after payday to receive their check. The hours missed will be deducted from the following pay period. Work Days the Employee Cannot Miss in Order to Receive a Regularly Scheduled Payroll Check on the Regularly The Rescheduled Payroll Dates Scheduled Payroll Dates Payroll Dates January 15, 1987 January 15, 1987 January 16, 1987 January 30, 1987 January 30, 1987 February 2, 1987 February 13, 1987 February 13, 1987 February 17, 1987 February 27, 1987 ' February 27, 1987 March 2, 1987 March 13, 1987 March 13, 1987 March 16, 1987 March 31, 1987 March 31, 1987 April 1, 1987 April 15, 1987 April 15, 1987 April 16, 1987 April 30, 1987 April 30, 1987 May 1, 1987 May 15, 1987 May 15, 1987 May 18, 1987 May 29, 1987 May 29, 1987 June 1, 1987 June 15, 1987 June 15, 1987 June 16, 1987 June 30, 1987 June 30, 1987 July 1, 1987 July 15, 1987 July 15, 1987 July 16, 1987 July 31, 1987 July 31, 1987 August 3, 1987 August 14, 1987 August 14, 1987 August 17, 1987 August 31, 1987 August 31, 1987 September 1, 1987 September 15, 1987 September 15, 1987 September 16, 1987 September 30, 1987 September 30, 1987 October 1, 1987 October 15, 1987 October 15, 1987 October 16, 1987 October 30, 1987 October 30, 1987 November 2, 1987 November 13, 1987 November 13, 1987 November 16, 1987 November 30, 1987 November 30, 1987 December 1, 1987 December 15, 1987 December 15, 1987 December 16, 1987 December`31, 1987 December 31, 1987 January 4, 1988 Signature Date 870251 Weld Count,, Division of Human Resources and .,ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C8 Subject: Employee Evaluation Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 59 Walter J. Speckman All employees will be evaluated at the end of the eight (8) week Memorandum of Agreement period. The initial Welfare Diversion Program is eight (8) weeks in length and combines work experience with job search activities. Each employee will be required to participate in job search activities that include job seeking skills, job obtainment skills, and job holding skills. The work site supervisor will be informed of each participant's scheduled activities for job search, instructional training, or institu- tional training to minimize disruption of the work site. 1. All jobs are entry-level positions. 2. For each entry into the Welfare Diversion Program, an Employee Evaluation (Attachment A) will be completed. 3. The evaluations will be used to make the following determinations: a. Termination of the employee. b. Reassignment of the employee to an additional eight (8) week program. c. Transfer of the employee to On-The-Job-Training. 4. The procedures for the use of the Employee Evaluation forms are as follows: a. The Work Site Supervisor and the Welfare Diversion Employee will complete the Employee Evaluation Form prior to the end of the eighth week of the Welfare Diversion Employee's Memorandum of Agreement period. b. The Employment Technician must sign and may comment on the evaluation. The evaluation form must be completed prior to the end of the Diversion Employee's Agreement. c. A new Welfare Diversion Employee Memorandum of Agreement cannot be signed without the completion of an Employee Evaluation and the updating of the Employability Development Plan. d. If the Work Site Supervisor does not complete the Employee Evaluation Form with the Welfare Diversion Employee, the Employment Technician will complete the form with the Welfare Diversion Employee. 870251 Page 60. WELFARE DIVERSIO Employee Evaluation Attachment A (sample of an ' Employee Evaluation) Name: SSN: Training Period: to Training Area: Kennel Attendant Internship Site: Internship Supervisor: Far Well Below Below Meets Above Not Not Performance Standards Standard* Standard* Standard Standard Observed Applicable A. Safety 1. Uses safe practices in operating equipment and carrying out all functions. 2. Lifts objects correctly by utilizing leg muscles instead of the back. 3. Observes all safety rules and procedures of the internship worksite. 4. Complies with the established safety procedures. S. Uses and wears protective equipment and safety devices as required. B. Attitudes and Professional Ethics I. Maintains appropriate personal hygiene and appearance. 2. Arrives at the job on time and is there each day as required. 3. Works cooperatively with fellow workers/ interns and treats others respectfully. 4. Accepts constructive criticism and follows instructions willingly. 5. Respects value of internship worksite and _personal property and cares for it properly. C. Job Specific Performance - Performs routine aide work in an entry-level or semi-training capacity. 1. Scrubs/cleans kennel runs and cages. 2. Feeds and handles dogs and cats. 3. Various maintenance cleaning. 4. Refers customers to regular staff employees. 5. Walks dogs on leashes for exercise. 6. Overall evaluation * Comment on those areas rated Below or Far Below Standard COMMENTS: Employee's Signature Date Internship Supervisor's Signature Date Employment Technician or Designee Date 870251 wtiire rnny. w.nan Researr.s Yellow cony: Participant Weld County division of Human Resources and _Jcial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C9 Subject: Employee Counseling Form Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 61 Walter J. Speckman The Employee Counseling Form is to be used to document counseling sessions held with a Welfare Diversion Employee. Counseling sessions shall be held to inform the employee of performance issues such as exceptional work performance or problems with punctuality, attitude, attendence, hygiene, etc. 870251 Page 62 Welfare Diversion Program Employee Counseling Form Name: Date: On the above date I counseled this employee concerning: IIII Work performance. (Performance deficiency in area specified below. ) Q other (specified below). n Any further violations of your Welfare Diversion Program Agreement or policies will result in immediate termination. Employment Technician or Designee Date Employee Comments: Employee Signature Date White Copy: File Yellow Copy: Employee 21-87-152 870251 Weld County division of Human Resources and -.ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C10 Subject: Counselor's Notes Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 63 Walter J. Speckman The "Counselor's Notes" are used to chronologically document the Employment Technician's conversations and/or actions taken with the Welfare Diversion Employee. The form is kept in the Employment Technician's Counseling file. 870251 Page 64 COUNSELOR'S NOTES Client's Name: SS#: Initial Interview Date: DOT: 1 ) Phone No. : 2) NOTES: Counselor's Signature: Date Signed: 21-79-119 870251 Weld Count_ Division of Human Resources ano .ocial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C11 Subject: Job Search Policy Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 65 Walter J. Speckman Job Search is an integral part of the Welfare Diversion Program and it is estimated that 80 hours of the eight week program are spent in job search activities which include skill development in job seeking, job obtainment, and job holding. Job Search is implemented through structured documentable means, as well as unstructured and hard to document means. The most unstructured, but perhaps the most important, aspect of job search is that which is pro- vided by the work site supervisor in the day-to-day interaction with the participant. This takes place mainly in providing the participants with experience in holding a job. The interaction and guidance provided by the supervisor definitely provides the participant with experience in relating to a supervisor and co-workers. Other hard to document job search activities are those which are con- ducted by the participant. While the Welfare Diversion Program staff can implement job search activities to assist the participant, the utilization of this training cannot be monitored. It is the participant's actual implementation of the information provided which will obtain the job for them. The remainder of this policy outlines specific structured and unstruc- tured procedures for job search activities which will be provided in the Welfare Diversion Program. While these procedures and information are not all inclusive, they will provide the framework for conducting job search and documenting these activities. Procedures I. Class Instruction Job Search will be conducted through class instruction in group sessions. A wide variety of topics will be covered. Some of these include: A. Safety Class All participants will be required to attend at least one class session on safety. The safety class will cover information pertaining to job safety, how to avoid accidents at work, proper ways to lift, etc. 870251 Page 66 B. _ Interview Class Participants will be required to attend an interview class. The interview class will consist of interviewing techniques, mock interviews, and feed back from the class and instructor on problem areas they foresee. The participants will become familiar with the expectations and results of interviews. C. Resume Writing Participants will be required to attend one resume writing class. The class will consist of various methods in preparing a resume which will meet the participant's and employer's needs. Assistance will be provided in writing a letter of introduction. D. Applications The application class will provide the participants with information on different types of applications, how to com- plete applications properly, common questions on an application, when it is appropriate to include a resume, etc. Participants will be required to attend one class. E. Labor Market Information The labor market information class will expose participants to the labor market for Weld County and surrounding areas. The class will include methods on how to locate potential jobs, identify agencies which can assist, use the Job Service, etc. Participants will attend one class. F. Job Search The job seeking class will address different methods of job seeking, including job contacts, procedures in using the telephone and telephone book as a job search tool , networking, etc. Participants will attend one class. G. Employment Etiquette The class will address areas regarding appropriate dress, behavior on the job, attitude, appearance, working with co-workers, etc. Participants will attend one class. H. Additional Classes When possible, guest speakers from various agencies or busi- nesses will be asked to conduct classes in their specific expertise. These topics may include employer expectations, money management, handling stress or a crisis situation, and other areas of concern to the participant. It is anticipated that the Welfare Diversion participant will spend a minimum of six (6) hours and a maximum of 15 hours in class during their eight week time period. 870251 Page 67 II. Individualized, Staff Job Search Training Employment Technicians will provide individualized job search training which includes such activities as, developing an employability plan; reviewing the primary and secondary DOT codes; counseling in areas of job contacts, job development, handling personal problems away from the job so it does not affect job performance, preparing an application, preparing for interviews and testing. It is estimated that staff will spend, at a minimum, forty-one (41) hours with or for each employee in individualized job search activities. III. Work Site Supervisor The work site supervisor plays a major role in preparing the par- ticipant for holding a job. This begins with initial orientation to the job and identification of expectations from the participant in the job. The supervisor provides a safety orientation; on-the-job counseling; work site expectations in appearance, dress, following chain of command, and office regulations; and may help in crisis management. In addition, the supervisor provides an employment evaluation. The job is structured to be as close to an unsubsidized job as possible, thus the participant gains knowledge and skills which can be used to hold an unsubsidized job. IV. Welfare Diversion Participant Job Search The participant is required to take an active role in job search if it is to be successful . This not only includes participation in structured activities through classes and contact with the employment technicians and work site supervisors, but through individual efforts. Job Search involves making allowable job contacts during participation in Welfare Diversion; seeking employment through Job Service; reviewing want ads; talking to neighbors, friends, etc. regarding possible jobs; going to job referrals made by the Employment Technician; participating in job development activities; filling out applications, etc. It is estimated that individual participant efforts in job search will include approximately 32 documentable hours during the eight week period. V. Documentation Procedures A. Record Keeping All MIS files are to have a copy of the Welfare Diversion Memorandum of Agreement, and a copy of the Welfare Diversion Registration Form stating a client is eligible for the Diversion Program. All Counseling Files will have an Employment Development Plan which reflects the type of component the participant is presently enrolled in and the period of time. The Employee Counseling Form and the Counselor's Notes are also in the file 870251 Page 68 to document specific counseling regarding job search and any "problem areas that may ariseduring participation in Welfare Diversion. All comments are to be in chronological order. Additional formal counseling sessions may be added as they occur. All information in this file is to be considered confidential , and is available only to authorized Employment Services staff in the Welfare Diversion Unit. B. ESWC Terminal Documentation for Job Search will be logged and kept on the Contact History portion of the terminal . Entries will be made throughout the client's participation in the Diversion Program. The sections of the screen that will be key factors in docu- mentation are as follows: Remarks, Type of Service, Type of Contact (516 AP) , and Job Order Referral (516 JO). The type of services which will be documented on the computer are: 1. Testing Participants will be referred to testing in the following areas: typing, spelling, and GATB or SATE Aptitude Testing by Employment Services of Weld County or Aims Community College. Documentation will take place on a 516 AP as a referral to testing. Later it will be input on the ESWC Contact History Screen. The Remarks section should note what type of test and what agency conducted the test. The hours of testing shall be determined by the average length of time each test takes. The Welfare Diversion Unit shall maintain documentation which can be reviewed for average length of testing time for a standard method. 2. Job Contacts During the employee's participation in the Welfare Diversion Program, job contacts shall occur and must be approved by the Employment Technicians only. A client must make his/her own contacts. This provides the participant hands on experience in seeking employment in the private sector, contacting actual employers, and filling out applications. Documentation will occur on the Contact History Screen. The Remarks section notes that job contacts have been approved and the amount of time allowed. The actual Employer Contacts - Job Search form, which the employee returns at the end of the day, is filed in the participant's payroll file only after the technician has reviewed it. Hours of job search training are documented by the allowable amount of time for each contact. Contact may be a half day or a full day. 870251 Page 69 ,3. Job Referrals Referrals to Job Service openings are documented on the Job Order Referral section of the computer. 4. Job Search Classes Attendance of job search classes and workshops, approved by the Employment Technicians, are documented in the Type of Contact section (516 AP). 870251 Page 70 Employer Contacts - Job Seat (Five contacts must be made in person) 1. Name of Company Company Phone # Name of Person Contacted Type of Work Applied for Date Results 2. Name of Company Company Phone # Name of Person Contacted Type of Work Applied for Date Results 3. Name of Company Company Phone # Name of Person Contacted Type of Work Applied for Date Results 4. Name of Company Company Phone # Name of Person Contacted Type of Work Applied for Date Results 5. Name of Company Company Phone # Name of Person Contacted Type of Work Applied for Date Results I certify that the information given on this form is correct and true. I understand that if any information given is incorrect or false, I may be subject to termination from the Job Search Program and may be liable to repay any allowance received because of the falsified information on this document. Participant's Signature Worksite 870251 White Copy - File Yellow COPY - Participant 21-87-213 Weld Count) Division of Human Resources and .1ucial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C12 Subject: Transportation Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 71 Walter J. Speckman Mini-Bus Transportation 1. For Welfare Diversion Employees who have had a vehicle breakdown and live outside the City of Greeley Transportation System, the Mini-Bus Transportation may be made available. The Employment Technician will contact the Transportation Director and make arrangements for pick up. The Mini-Bus will be available for work related activities. It is not intended to provide employees transportation to food stamp appointments, doctors appointments, or other personal appointments. 2. All Welfare Diversion participants are provided a leave-without-pay day after the registration/orientation to take care of transportation problems. Subsequent time needed for major transportation problems, will be charged to emergency leave for a total of eight (8) hours. 870251 Weld County Division of Human Resources and _octal Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C13 Subject: Compensatory Time Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 72 Walter J. Speckman There will be no compensatory time given to employees unless previously authorized. This authorization must be in writing and authorized by the Director of the Employment Services of Weld County (ESWC). If an employee misses time, this time cannot be made up by working other hours. 870251 Weld County Division of Human Resources and _dcial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C14 Subject: Snow Days and Other Extreme Weather Conditions Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 73 Walter J. Speckman If the work site is closed because of snow or other extreme weather conditions, the Employee will immediately notify their designated Employment Technician. The Employee shall be provided an excused leave- without-pay day. If Employment Services of Weld County (ESWC) is also closed, the employee must call their Employment Technician the following day to report their absence from work on the previous day due to weather conditions. If the work site is open and the employee resides near the Greeley bus system or within walking distance, the Employee must report to work. Absence will be considered unexcused. The only instance in which emergency leave can be used for major transportation problems is if the Employee lives outside the Greeley Transportation System and is not within walking distance. The ESWC Director is the only one authorized to grant a leave-without-pay day due to snow or extreme weather conditions. If the Employee is scheduled for tranportation by the Mini-Bus, and the Mini-Bus is not operating for that day, leave-without-pay will be authorized. 870251 Weld Counts Division of Human Resources and Jcial Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C15 Subject: Work Site Description and Non-Financial Agreement Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 74 Walter J. Speckman 1. The work experience sites shall be either public or non-profit agencies. Each work site will be required to have a work site Non-Financial Agreement (Attachment A) signed by both the work site and ESWC. 2. The Employment Technician Supervisor makes the assignment of work site/duties based on work site availability, employee's physical limitations, and the Welfare Diversion Polices and Procedures. As the Employer, Employment Services of Weld County assigns all duties and work positions. It is an Employment Services policy that the Employee will not be reassigned to the same work site, with the same job duty description. This means that the work site assignment will change at the end of each eight (8) week employment assignment. ESWC makes the final determination of work assignments and duties. 3. Welfare Diversion Program employees will not be placed at the same work site (doing the same tasks and under the same supervisor) with a Diversion employee that is a relative, nor will a Diversion employee be placed at a work site where her/his child care is being provided. For this section only, a relative is defined as a mother, father, brother, sister, grandparents, son, daughter, step-son, step-daughter, step-mother, step-father, husband, wife, mother-in-law, father-in-law, foster parent, foster child, aunt, uncle, niece, nephew, grandfather, grandmother, niece, nephew, cousin, or any other person sharing the relationship of in loco parentis. If problems arise in work site assignments, a staff meeting must be held to solve the problem or provide an alternative solution. No Diversion employee will be placed in a work site supervised by a relative or at a site where any relative is employed (non-Diversion, doing the same tasks, and under the same supervisor). 4. Work sites will be evaluated (Attachment B) twice a year to ascertain concerns, weaknesses, and strengths to the program. 5. Individual work site supervisors will be personally contacted at least once during a two (2) week period. 870251 Page 75 Attacf It A WELFARE DIVERSION PROGRAM Non-Financial Agreement This Agreement is made this day of 198 , by and between the Weld County Division of iuman Resources' Employment Service-Fa Weld County, hereinafter designated as "ESWC", and the public or private non-profit agency entering this Agreement by signature, hereinafter referred to as "Agency". WITNESSETH: WHEREAS, ESWC conducts a Welfare Diversion Program for eligible applicants, and WHEREAS, ESWC provides work experience and job search employment activities for participants in the Welfare Diversion Program, and WHEREAS, the Agency can participate in the Welfare Diversion Program as a work site for the participants, and WHEREAS, ESWC and the Agency desire to work together for the express purpose of providing work experience for the participants. NOW THEREFORE, in consideration of the implementation of these goals the parties hereby agree to the following: A. ESWC agrees to: 1. Provide an orientation session to the Agency outlining the specific processes the Agency will need to follow as a work site. 2. Refer, if available, the agreed upon number of participants to the Agency for work experience. 3. Pay minimum wage for the hours of work completed by the participants. 4. Handle all check disbursements to the participant. 5. Monitor attendance in conjunction with the Agency. 6. Provide Worker's Compensation coverage for all participants. B. The Agency agrees to: 1. Provide a productive work period wherein the Welfare Diversion participants can develop work habits and gain work experience. 2. Furnish all equipment and materials deemed by the Agency and ESWC as reasonably necessary to ensure the continuing accomplishment of the program objectives. 3. Accept only the number of Welfare Diversion participants who can be utilized productively. 4. Ensure that regular full-time or part-time employees are not replaced with Welfare Diversion participants. 5. Report to the designated ESWC representative the days and hours the participant worked. 870251 Page 76 Welfare Diversion Program Non-Financial Agreement Page 2 6. Provide supervision and adequate training in the use of equipment and/or procedures required to perform the job. 7. Grant the participants time off, as deemed necessary and appropriate by ESWC, to secure unsubsidized employment. 8. Treat all Welfare Diversion participants in the same manner as other employees of the Agency relative to such issues as safety and job performance. 9. Participate with ESWC in the evaluation of the Welfare Diversion participant's job and job-holding performance. 10. Contact ESWC in the event of a question or issue regarding failure to participate or disruptive behavior on the part of the participant at the work site. 11. Assist ESWC, upon ESWC's request, in disputes with the participants. 12. Follow the process as outlined in the orientation session, provided to the Agency by ESWC, regarding Worker's Compensation and injuries involving the participant. C. ESWC has the sole authority to dismiss a participant within the guidelines of the Welfare Diversion Program and the participant's Memorandum of Agreement and Terms and Conditions. The Agency shall not discriminate against the participant on the basis of race, color, religion, sex, national origin, age (40-70), handicap, or political affiliation or belief. D. This Agreement may be terminated at any time by either party. The Agency and ESWC mutually agree to participate in the Welfare Diversion Program in strict accordance with the terms and conditions herein specified. WELD COUNTY DIVISION OF HUMAN RESOURCES AGENCY Employment Services of Weld County (ESWC) WELFARE DIVERSION PROGRAM ESWC Representative Agency Representative Date Agency Name 870251 Welfare Diversion Page 77 Attachment B Work Site Evaluation GENERAL INFORMATION Work Site: Report Date: Supervisor: Work Site Location: WORK SITE EVALUATION s a, ov v ., > .�o-O v v u m ¢� > Oa'o 3 v )n -O CV-O mf- CC C Y C > C � C L Cr 1pY OY N4-4 N O CO r"' 4O Y V) 14- V) CO VI f N CU) 3v) ZO 1. Is the Direct Supervisor knowledge- able of his/her responsibilities within the Welfare Diversion Program? , 2. Does it appear that there is suffi€ient/productive work for the Welfare Diversion Employee? 3. Does there appear to be adequate t supervision? 4. Is there an adequate system for time and attendance? 5. Are necessary equipment and materials to accomplish the work tasks provided? 6. Are there alternative arrangements available for inclement weather? 7. Does the worksite appear to have safe and sanitary conditions? Proper safety gear provided? 8. Does the worksite abide by the applicable regulations, including non-displacement of regular workers, non-discriminatory activities? 9. Overall Evaluation COMMENTS Employment Technician Worksite Supervisor T 870251 Weld Count. Jivision of Human Resources ano .acia1 Services POLICIES AND PROCEDURES Section: Welfare Diversion Program Policy Number: 87-C16 Subject: Private Sector Internship Procedure Date: March, 1987 Department Head Concurrence: Eugene McKenna Page: 78 Walter J. Speckman The Private Sector Internship (PSI) was developed for the client actively enrolled in the Welfare Diversion Program. The PSI is designed to provide the client with an opportunity to work in the private sector. During participation, the PSI client will be assigned to a private sector site for twenty (20) hours per week and to a public sector site for the remaining twenty (20) hours. Because PSI is a component of Welfare Diversion, the participant will be subject to the terms and conditions set up for all Welfare Diversion clients. The participant will be paid minimum wage, and is provided with Workman's Compensation and Medicaid. Attendance, punctuality, and work performance will be monitored by an Employment Technician in conjunction with the work site supervisor. Because the primary purpose of the PSI Program is to expose the client to the private sector, a PSI employer is under no obligation to hire the client assigned to him. The employer is, however, encouraged to consider the client for any available positions for which the client qualifies. Increased exposure of the client to the private sector can only enhance the client's opportunities in obtaining unsubsidized employment, thereby decreasing the client's need for welfare assistance and lowering the burden to the taxpayers. 870251 Hello