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Work Try Out (WTO) Description | WTO Agreement | WTO Evaluation
WORK TRY OUT Agreement
WTO For: __________________________________(VESID Consumer)
Employer: _______________________Tel:___________________
Address: ______________________________________________
________________________________________________________
Job Title: ____________________________________________
Dates of WTO: Start______________ Finish_________________
Total Hours: _____________ From __________To______________
-
Rate of pay shall be______ hr. VESID will reimburse the employer for the
hourly wages of the employee for a maximum of four weeks or 160 hours,
whichever comes first. Fringe benefits will not be reimbursed.
Payment to the employer will be made upon completion of the WTO. - Employer will place WTO/VESID consumer on the payroll and cover Worker’s Compensation. Social Security, and Unemployment during the WTO Period. All Department of Labor Standards for wage, hours and safety will be met, and the employer will afford that person all benefits and company policies applicable to other employees in similar job status.
- The VESID Counselor or designated representative will make contact with the employer during the WTO period. The employer will contact VESID counselor if there are concerns.
- Employer will complete a brief VESID evaluation upon completion of the WTO to be included with the voucher requesting payment.
- The employer is not an immediate relative of the WTO VESID consumer.
Employer Signature
________________________________Date__________
Employer Federal ID# ____________________
To
be filled out by VESID Counselor &/or Designated Agency Representative
VESID Counselor _______________________________ Date:____________
Designated Representative (If applicable)____________________________
