Form 22-8865 Employer's Application to Provide Job Training

OMB Approved No. 2900-0342
Respondent Burden: 90 minutes

EMPLOYER’S APPLICATION TO PROVIDE JOB TRAINING
(UNDER TITLE 38 U.S. CODE SECTION 3677 OR 3687)
INSTRUCTIONS: All items should be completed. Information requested in Section II applies to the particular trade, craft or occupation for
which you propose to provide training to veterans and their eligible dependents. Please read Section III carefully before signing the
application. The completed application form may be submitted directly to the VA office serving the area where your establishment is located.

SECTION I - EMPLOYER IDENTIFICATION
1. NAME OF ESTABLISHMENT

2. NAME AND TITLE OF PERSON TO CONTACT
(Include e-mail address)

4. LOCATION OF ESTABLISHMENT (Street No., city, State, Zip Code)

3. TELEPHONE NO. (Include
Area Code)

5. MAILING ADDRESS (If different than in Item 4)

SECTION II - DESCRIPTION OF TRAINING PROGRAM
6. JOB TITLE (Position for which training will be provided)

8. LENGTH OF PROGRAM (Indicate
hours or months)

7. JOB DESCRIPTION (Please keep brief)

9. HOURS IN STANDARD WORK WEEK

10. HOURS OF RELATED TRAINING 11. NUMBER OF FULLY QUALIFIED
OUTSIDE OF JOB REQUIRED EACH EMPLOYEES AVAILABLE AS INSTRUCTORS
YEAR (If none, write "None")
FOR EACH TRAINEE
12. MAXIMUM NUMBER OF TRAINEES THAT CAN BE TRAINED AT ANY ONE TIME

SECTION III - WAGE PROGRESSION SCALE
13. BEGINNING WAGE FOR TRAINEES

14. PRESENT JOURNEYWORKER WAGE

15. WAGE PROGRESSION DURING TRAINING
A. PERIOD

B. NO. OF MONTHS

C. WAGE LEVEL

A. PERIOD

B. NO. OF MONTHS

C. WAGE LEVEL

1ST
2ND

$
$

PER
PER

6TH
7TH

$
$

PER
PER

3RD

$

PER

8TH

$

PER

4TH
5TH

$
$

PER
PER

9TH
10TH

$
$

PER
PER

SECTION IV - CONDITIONS TO BE MET
I UNDERSTAND AND AGREE THAT THE FOLLOWING CONDITIONS MUST BE MET IF THIS TRAINING PROGRAM IS
APPROVED FOR VA TRAINING BENEFITS:
A. Close supervision by qualified journeyworkers will be provided throughout the training program.
B. Records will be maintained for each trainee. At a minimum, the records will include the following: job assignments, promotions,
demotions, lay-off terminations, rates of pay, progress in training as outlined in the work processes, hours of training given monthly in each
process and overall progress evaluations made at least each 3 months.
C. Credit will be given for previous training and experience and the length of the training program will be reduced proportionately.
Trainees who are granted credit for previous training and experience will be placed into the appropriate step of the wage progression scale.
D. If required for approval of a training program, the trainee will be advanced to the full journeyworker wage immediately upon
completion of the training program.
E. An Enrollment Certification will not be submitted for a veteran or eligible person who is already qualified for the position because of
prior training or experience.
F. A copy of an approved training agreement will be provided to the trainee and to the Department of Veterans Affairs (VA).
G. Immediately notify VA of any wage increase (or decrease) paid any trainee not in accordance with his or her training agreement.
IN ADDITION, FOR ON-THE-JOB TRAINING OTHER THAN APPRENTICESHIP PROGRAMS, I HEREBY CERTIFY THAT:
H. The wages paid to trainees under this VA program will not be less than wages paid to trainees who are not eligible for VA benefits. The
beginning wage will be at least 50% of the wage for a fully trained employee.
I. Unless the training establishment is operated by a Federal, State or local government, periodic wage increases will be granted and by the
last full month of training the wage will be at least 85% of the wage for a fully trained employee.
J. There is a reasonable certainty that the job for which training is provided will be available to the trainee after training has been
16. SIGNATURE

VA FORM
DEC 2010

22-8865

17. TITLE

EXISTING STOCKS OF VA FORM 22-8865, NOV 2007,
WILL BE USED.

18. DATE SIGNED

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 as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and
Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. An example
of a routine use allows VA to send educational forms or letters with a veteran’s identifying information to the
veteran’s school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for
VA to obtain further information as may be necessary from the school for VA to properly process the veteran’s
education claim or to monitor his or her progress during training. Your obligation to respond is required to
obtain or retain education benefits. While you do not have to respond, VA cannot determine if your training
program can meet the requirements set by law for VA approval unless the information is furnished. The
responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to
verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to determine whether a training program may be
approved by the Department of Veterans Affairs (VA), (38 U.S.C. 3677 or 3687). Title 38, United States Code,
allows us to ask for this information. We estimate that you will need an average of 90 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 http:www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-888-GI-BILL-1
(1-888-442-4551) to get information on where to send comments or suggestions about this form.

VA FORM 22-8865, DEC 2010