On-The-Job Training (OJT) Progress Report & Invoice

On-the-Job Training (OJT) Progress Report & Invoice

Invoice Number: / Date:

For prompt payments, please submit this form to each month, incl. time and attendance, payroll, and other records to support amounts invoiced.

Submit W-9 with first invoice.

(I)Business Information

Legal Business Name: / FEIN or UBI #:
Business Address: / City, State, ZIP:
OJT Employee Supervisor: / Accounts Receivables Contact:
Phone: / Phone:
Email: / Email:

(II)Employee Information

OJT Employee Name: / State ID#: / Voucher ID#:
Case Manager Name: / Email: / Fax:

(III)Progress Information

Unsatisfactory Progress / Satisfactory Progress / Fully Proficient / Date Measured:
Unsatisfactory Progress / Satisfactory Progress / Fully Proficient / Date Measured:
Unsatisfactory Progress / Satisfactory Progress / Fully Proficient / Date Measured:
Unsatisfactory Progress / Satisfactory Progress / Fully Proficient / Date Measured:
Unsatisfactory Progress / Satisfactory Progress / Fully Proficient / Date Measured:
Competency / Rating
Punctuality / Poor / Marginal / Good / Very Good / Excellent
Attitude/Conduct / Poor / Marginal / Good / Very Good / Excellent
Motivation/Initiative / Poor / Marginal / Good / Very Good / Excellent
Appearance/Hygiene / Poor / Marginal / Good / Very Good / Excellent
Overall Progress Rating / Poor / Marginal / Good / Very Good / Excellent
Is trainee projected to achieve full proficiency in all job functions in the time period stipulated in the OJT contract? / Yes No
Are there any specific concerns or items you would like for SC Works Staff to discuss with the trainee? / Yes No
Comments or Concerns: ______

Equal Opportunity Employer/Program.

Rev. 04/13Auxiliary aids and services are available upon request to individuals with disabilities. TTY 711Page 1 of 2

(IV)Reimbursement Information

Total Contract Hours: / Contract Start Date: / Contract End Date:
Reimbursement Period Start Date: / Reimbursement Period End Date:

Use the below calendar to record only reimbursable hours (in ¼ hr increments) for the invoice period. Reimbursement for the extraordinary costs of training will be % of the standard wage, as outlined in the OJT contract. Holidays, sick time, vacations, overtime, weekend pay, etc. will not be reimbursed.

SUNDAY / MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAY / SATURDAY
Date / Hours / Date / Hours / Date / Hours / Date / Hours / Date / Hours / Date / Hours / Date / Hours

Equal Opportunity Employer/Program.

Rev. 04/13Auxiliary aids and services are available upon request to individuals with disabilities. TTY 711Page 1 of 2

OJT Wage Reimbursement
Hours Worked in this Reimbursement Period (in ¼ hr increments):
Hourly Wage: / $
Total Wage: / $
Reimbursement Rate: / %
Total Wage Reimbursement: / $
Amount Invoiced: / $
Tools, Supplies, & Other Reimbursements
(Please include applicable receipts/support documentation.)
Item / Price
$
$
$
$
$
Total / $

Equal Opportunity Employer/Program.

Rev. 04/13Auxiliary aids and services are available upon request to individuals with disabilities. TTY 711Page 1 of 2

By signing below, I affirm that all information provided above is true and accurate to the best of my knowledge. I understand that any deliberate falsifications, misrepresentations, or omissions of facts in order to obtain or increase benefits is FRAUD and may be ground for contract termination and other severe penalties, in which case I will be held financially responsible for all incurred program costs and disqualified from future OJT contract options. I certify that the amount claimed on this invoice is in accordance with the terms of the Contract.

Employer Authorized Representative Signature / Date
OJT Employee Signature / Date
FOR SC WORKS STAFF USE ONLY

I certify that the employer has satisfactorily met the conditions of the Contract and qualifies for payment.

TAA/WIA Authorized Representative Signature / Date
FOR ACCOUNTS PAYABLE STAFF USE ONLY
WIA Adult / WIA Dislocated Worker / WIA In-School Youth / WIA Out-of-School Youth / TAA Dislocated Worker
Amount To Be Paid: / $ / Authorized By: / Date Processed:

Equal Opportunity Employer/Program.

Rev. 04/13Auxiliary aids and services are available upon request to individuals with disabilities. TTY 711Page 1 of 2