EMPLOYMENT SERVICES

Welcome to the SEIU Healthcare 1199NW Multi-Employer Training and Education Fund!

NOTE: PER DIEM & CONTRACT EMPLOYEES ARE NOT ELIGIBLE FOR THIS SERVICE

Today's Date

First Name

Middle Initial

Last Name

Home Street

Home City

Home State

Home Zip/Postal

Preferred Phone Number

Mobile Phone

Work Phone

Home Phone

Preferred Email

Employer

Bargaining Unit

Current FTE

Job Title

Hire Date

How can we help you? (Select all areas of interest)

I would like help to fine tune my job search strategyI would like help to set career goalsI would like help with my resume/cover letterI would like to meet to practice interviewing skillsOther

Other way(s) we can help you

Lead Source

Record Type

Opportunity Name

Opportunity Stage

https://healthcareerfund.org/wp-content/uploads/2018/08/Final-confidentiality-statement.pdf
Please Note that in completing the attached "Application," you are also agreeing to the following statement:

I have had the opportunity to read and review the SEIU Healthcare 1199NW Training Fund Privacy Policy. By filling out and submitting this Application/Intake Form, I agree to this Privacy Policy and authorize the Training Fund to contact, on my behalf, current or previous employers or educational institutions, or other relevant entities, to obtain information that may be necessary for the administration of the Training Fund's benefits. I further understand this authorization is on-going for the purposes of administering the Training Fund's benefits.

I agree

DATA SHARING WITH LABOR MANAGEMENT PARTNERS

The SEIU Healthcare 1199NW Training Fund provides specific details about active members' usage of Training Fund programs and services to both employer and labor partners. Sharing this information allows labor/management partners to do more targeted workforce planning, and also support individuals in their career and programmatic path. Data that we share does not include Date of Birth and Social Security Number.

Do you agree to allow the Training Fund to share your information with SEIU Healthcare 1199NW:

Do you agree to allow the Training Fund to share your information with employer partners:

TEXT MESSAGING POLICY

Your education and career advancement and training opportunities are important to us. In order to provide you with the up-to-date-service, we occasionally send text messages to our members about their education and training benefits and services. Standard text messaging rates apply.

By completing this form, you authorize text messaging from Fund unless you decline text messaging. To decline Text Messages, email your Regional Education Navigator or members@healthcareerfund.org stating that you do not want to receive text messages.

You can decline text messages at any time. Under some circumstances this may delay your receiving information on your program(s). Please talk with your Navigator (if you don’t have one, one will be assigned on submittal of this form) if you have questions on text messaging.

PHOTO/VIDEO USE POLICY – TRAINING FUND EVENTS

The ability to communicate about Training Fund services to our members and to use information gathered in classes and sessions for further training is important to the Training Fund.

Unless you decline photo/video by the Fund, by completing this form you authorize and agree that the SEIU Healthcare 1199NW Multi-Employer Training & Education Fund and SEIU Healthcare 1199NW may use photographic images or video footage of you, or in which you are included, taken during Training Fund related classes, sessions, or events, for public relations, program marketing, electronic media, or educational purposes.

To opt out from photo/video use, please send a separate email your Regional Education Navigator or members@healthcareerfund.org stating that you do not want your images/video to be used for Training Fund purposes.

You may opt out of photo/video use at any time. Please talk with your Navigator (if you don’t have one, one will be assigned on submittal of this form) if you have questions on photo/video use.

NON-DISCRIMINATION POLICY STATEMENT

The Training Fund is dedicated to equal opportunity education and training. It does not discriminate on the basis of race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, physical or mental ability, veteran status, military obligations, background, or marital status.

VERIFICATIONS

I certify that the information provided is true to best of my knowledge. I am aware that the information I have provided is subject to review and verification, and I may have to provide documentation to support the information provided.

I certify that the information provided is true to best of my knowledge

I authorize release of this information for verification purposes and for determining eligibility for services and Training Fund and non-training Fund benefits. I agree to the Training Fund Privacy Policy. I understand that receiving services is subject to availability of funding and that training and/or services are not guaranteed.

I authorize release of this information

I desire to be screened for benefit eligibility and enrollments. I authorize the release of my information and job placement data to Training Fund staff and affiliates for program monitoring, research, verification, additional data collection, and evaluation purposes.

I agree

I understand for educational and grant purposes, my employment status may be tracked after completion of my educational support. In order to verify the information or conduct further program evaluation, I understand the Training Fund may need to collect additional information from records at government agencies. This information may include but not be limited to Washington State Employment Security Department, Social Security Administration, Washington State Basic Food Employment and Training, or TANF (Temporary Assistance to Needy Families) records.

I understand the Training Fund may need to collect additional information.

I agree

Thank you! Training Fund staff will get back to you soon.

Contact Information