National Institute of Corrections

Form B

(This form may be duplicated.)

NATIONAL INSTITUTE OF CORRECTIONS

Offender Workforce Development Specialist (OWDS) Indiana Partnership Training

Individual Application

PLEASE READ:To apply, please complete and sign this form, include your resume or specific listing of criminal justice work history, obtain the necessary endorsement and mail to OWDS: Team Indiana, 2010 East New York St., Indianapolis, IN 46201.To receive full consideration, each item on both pages of this application must be completed -Incomplete applications will be returned. Thoseaccepted for participation will receive confirmation via email on or beforeJuly 20th,2015and additional information about the program will be distributed via email in early August.(There will be a waiting list maintained)To avoid schedule conflicts, each applicant should mark personal and work calendars as though you will be accepted to the training and attending 8:00am-5:00pm daily.

There is a $400 fee (to be paid upon acceptance to training) which includes: Full 3 weeks of Training,Take-home Materials, Practical Tools, Available Resources, Breakfasts and Lunches (27 meals provided),Future Team & Instructor Support and the Offender Workforce Development Specialist Certification through the NIC.

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Training program title: OWDS Indiana Partnership Training

Spring Training program dates:

Wk. # 1: September 14 – 18, 2015

Wk. # 2: October26 – 30,2015

Wk. # 3: December 14 – 18, 2015

Postmark date for applications: 07/10/15

Mr. _____ Ms. _____ Mrs. ____

Name DOB / /

Title Yrs. in position

Primary job responsibility is staff training? Yes ___ No ____

Agency

Mailing address

City County

State Zip code

Telephone ( )_____

Fax ( )_____

E-mail @

Primary work place (check one):

_____ Adult jail

_____ Adult community corrections

_____ Adult prison

_____ Other state or county agency (explain)

_____ Community College or University

_____ Post-release non-profit organization

_____ Faith-based or community organization

_____ Other (explain) ______

Type of agency (check one):

_____ Federal – Bureau of Prisons

_____ Federal – Other

_____ State

_____ Local

_____ Regional

_____ County

_____ Faith-based

_____ Non-Profit

_____ Private

Agency/Institution Information:

Institution/Facility Population ______

Or

Agency Population Served ______

Total number of agency staff ______

Number of staff you supervise ______

Shirt / Jacket Size:

Small Med Large XL XXL XXXL XXXXL XXXXXL

Checklist for submitting this application:

individual team member must complete page one;

applicant’s Executive Officer must complete page two;

individual team member’s supplementary information must be attached(resume or work history);

individual team member meets the combination of experience and education requirements for Global Career Development Facilitator (GCDF) certification. (requirements found at:

PLEASE READ CAREFULLY

I, the applicant, agree to:

apply for GCDF certification from Center for Credentialing and Certification, Inc. (CCE);

fully participate in this program and complete all pre- and post-training assignments, practicum assignments and evaluation instruments;

attend all scheduled training dates during the 3 weeks (barring any unforeseen emergencies);

coordinate and collaborate with other service providers and OWDS: Team Indiana to secure the necessary resources to provide workforce development training to other Indiana offender employment service providers;

obtain access to a computer with Internet and CD-ROM capability to complete practicum and video assignments, as necessary;

assume an integral role in the implementation of components of workforce development training in the jurisdiction after participation in this training is complete.

______

Signature (Individual Team Member) Date

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Please note: Individuals who are currently in a paid or volunteer position with an agency that provides service(s) for people who may have a criminal history are welcome to apply and participate in Indiana’s OWDS trainings. Because of this, it is probable people who have a criminal history will be participating in OWDS training. If this is of concern, please contact the Program Director.

ENDORSEMENT OF APPLICATION BY AGENCY CHIEF EXECUTIVE OFFICER

OWDS: Team Indiana will return as “incomplete” application forms that do not have the endorsement of the chief executive officer of the agency, as defined below.

For county jails - if the jail is under the sheriff, the sheriff must endorse the application. If not, the application must be endorsed by designee.

For prisons - the facility superintendent or executive staff member of the state department of corrections.

For community corrections - the head of the agency, such as the executive director, chief probation officer, or director of the community corrections department, depending on the organizational structure of the agency.

For employees of the Federal Bureau of Prisons - the facility warden or assistant warden.

For employees of Federal Probation - Administrator of local Federal Probation Office.

For employees of all other service providers and/or agencies - this application, to be signed by the CEO of the trainee’s agency.

NOMINATION/ENDORSEMENT

Nomination/Endorsement must be made by the Chief Executive Officer as defined above.

I recommend ______from this agency for participation in the National Institute of Corrections’ Offender Workforce Development Specialist Partnership training program for which this application is being submitted. This nomination is made on the basis that the candidate is in a position to effect and document improvement in our organization based on this NIC training opportunity.

This Agency will provide the training fee of $400 upon the nominee’s acceptance into the training. The nominee will be excused from their work assignment for the three weeks required by this training and be provided the time for work toward training completion between the weeks of the training (totaling 180 hours).

I agree to collaborate and coordinate with other co-sponsoring agencies as necessary to support the training team’s efforts to plan, develop, manage and evaluate the plan which will be the team outcome of OWDS training in my jurisdiction. I agree to support trainees’ application of skills, knowledge, and abilities as Offender Workforce Development Specialist. I agree to fully participate in NIC’s efforts to evaluate the impact of its training efforts.

The applicant-provided information on page one is accurate and complete.

Signature of Chief Executive Officer Date Type or Print Name

Title of Chief Executive Officer Telephone

______

Email of Chief Executive Officer

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