Form 28-1904 Agreement to Train On The Job Disabled Veterans

OMB Approved No. 2900-0678
Respondent Burden: 15 Minutes

AGREEMENT TO TRAIN ON THE JOB DISABLED VETERANS
(Chapter 31, Title 38, U.S. Code)
Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or
Title 38, Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 58VA21/22, Compensation, Pension, Education and
Rehabilitation Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The requested information is
considered relevant and necessary to determine maximum benefits under the law. Payment of accrued benefits cannot be made unless the information requested is
furnished as required by existing law (38 CFR 3.1000 and 3.1001). The responses your submit are considered confidential (38 U.S.C. 5701). Any information
provided by applicants, recipients, and others may be subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine, establish or verify your eligibility for VA Vocational Rehabilitation and Employment benefits (38
U.S.C. 5902). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of of 15 minutes to review the
instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is
displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send
comments or suggestions about this form.

THIS AGREEMENT, entered into as of the
Establishment)

day of

, 20

, between (Legal Name and Address of the

(hereinafter referred to as the Establishment) and the Department of Veterans Affairs for the purpose of implementing the
provisions of Chapter 31, Title 38, U.S.Code with reference to training on the job of disabled veterans, provides:
A. That the Establishment will:
1. Accept, from time to time and within its own discretion in each case, disabled veterans for a course of training on the job
which will render each employable in accordance with the provisions of law for the following job objectives:
JOB OBJECTIVE

LENGTH IN MONTHS

2. Maintain in its file a detailed course of training for each occupation for which training will be made available to veterans.
3. Provide competent instruction to each veteran in accordance with his or her individual training program prepared by the
Department of Veterans Affairs in collaboration with the Establishment, subject to such subsequent modifications as may
be mutually agreed upon as being necessary to effect the successful rehabilitation of each veteran.
4. Provide close supervision of each veteran while he or she is undergoing training, in order that the employment objective
may be reached within the time limits stated in his/her individual training program.
5. Furnish, at the Establishment’s expense, to each veteran such books, tools, equipment, and material as are customarily
furnished without cost by the Establishment to all other trainees in the same course.
6. Maintain adequate progress reports which will at any time disclose the performance of each veteran in training.
7. Report to the Department of Veterans Affairs Regional Office serving the area in which each veteran is receiving training,
in such form and at such times as may be required, information as to the conduct and progress of each veteran in
training,
and the amount of wages plus any other remuneration paid to him or her by the Establishment.
VA FORM 28-1904
OCT 2005

8. Report immediately to the Regional Office of the Department of Veterans any situation regarding each veteran in training
which indicated the need for attention of the Department of Veterans Affairs.
9. Cooperate with the Department of Veterans Affairs in the carrying out of any supervisory function required for the
Department of Veterans Affairs by law and Veterans Affairs regulations.
10. Upon completion of the training, issue to each veteran a signed statement or certificate which will indicate the length and
type of training provided, and the fact that he or she has satisfactorily completed his or her individual training program.
B. That the Department of Veterans Affairs will:
1. Enter veterans as they are eligible and available into those training programs in which the Establishment will
accept them.
2. Exercise supervision of the veterans in training to the extent necessary to protect the interest of the Federal Government
and the veterans.
3. Furnish to each veteran, at the expense of the Department of Veterans Affairs, such books, tools, equipment, and
materials, in addition to any supplied by the Establishment, commonly required by the Establishment to be supplied
and personally owned by other trainees, not under the Veterans Affairs jurisdiction, pursuing the same training in the
Establishment.
4. Assume the responsibility of keeping the Establishment currently informed of any and all modifications of the law and
Veterans Affairs regulations affecting the training program for disabled veterans.
5. Remove from training status any veteran whose personal conduct, lack of application to his or her training, or
unsatisfactory quality of work is such as to jeopardize the interest of the veteran, the Establishment, or the Veterans
Affairs, provided, however, that when a veteran is being trained under terms of apprentice indenture, the terms of such
indenture shall control insofar as such terms are not incompatible with the provision of the law governing the veteran’s
training, or with the interests or policies of the Department of Veterans Affairs.
C. Further, that:
1. Each veteran in training under this Agreement will be under the control and supervision of the Establishment and will
be subject to the same rules and regulations governing the conduct of other comparable employees of the Establishment.
2. This Agreement may be terminated by the Establishment or the Department of Veterans Affairs on fifteen (15) days
notice.

FOR THE ESTABLISHMENT
DATE

SIGNATURE

TITLE

DATE

SIGNATURE OF VOCATIONAL REHABILITATION AND EMPLOYMENT REPRESENTATIVE

FOR THE DEPARTMENT OF VETERANS AFFAIRS
NAME AND LOCATION OF VA
REGIONAL OFFICE
DEPARTMENT OF VETERANS AFFAIRS