ETA 678 Job Corps Placement Record

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Career Transition System
U.S. Department of Labor
Employment and Training Administration

OMB Approval No: 1205-0035
Expiration Date: 11/30/2013

JOB CORPS PLACEMENT RECORD
1. STUDENT ID

2A. LAST NAME

2B. FIRST NAME

2C. MI

MO

DAY

YEAR

7. DATE OF BIRTH
MO

4. PHONE NO.

5B. EMAIL

5A. STREET ADDRESS, CITY, STATE, ZIPCODE

6. SEPARATION DATE

3. SEX

9. ASGN

8. CENTER CODE

10. GED

11. COMPLETION

12. GRAD STAT

DAY YEAR

13. STUDENT'S CTT TRAINING
A. TAR Code

B. Title

C. TPA

D. Training Provider

14. STUDENT'S PLACEMENT STATUS ON DATE THIS FORM COMPLETED
PLACEMENT
STATUS:

01
02
03
04
05

One Full Time Job
Two Full Time Jobs
One Part Time Job
Two Part Time Jobs
Armed Forces

06
07
08
09
10

15. CTS CODE

Full Time Job/College Combo
Part Time Job/College Combo
High School / GED
Post Secondary School/Training
College

11
12
13
14
15

OJT/Subsidized Employment
Other Training Program
NP Family Obligations
NP Reentered Job Corps
NP Seeking Placement

16
17
18
21
22

NP Not Seeking Placement
NP Cannot Locate
NP Other
NP Referred to One-Stop Ctr
NP Referred to other agency

16. INITIAL
PLACEMENT

17. JOB, SCHOOL, MILITARY OR NOT PLACED INFORMATION (FIRST)
A. Registered
Apprenticeship

B. ONET SOC

C. TPA

D. Hours

E. Hourly Wage

F. Job Title

G. JTM

18. EMPLOYER, SCHOOL OR INSTITUTIONAL TRAINING PROGRAM (FIRST)

19. NON-PLACER

A. Name

D. Area Code & Phone No.

F. Email

Was Student
Placed By NTC?

B. Number and Street Address

E. Fax No.

G. Web Site

C. City, State, ZIP Code
20. PLACEMENT VERIFICATION (FIRST)
C. DATE STUDENT REPORTED

A. CONFIRMATION OF PLACEMENT / SELF - EMPLOYMENT STATUS
Name

Title

Phone No.

B. OTHER/COMMENTS

MO

DAY

YEAR

D.DATE STUDENT PLACED
MO

21. NAME AND TITLE OF OFFICIAL VERIFYING PLACEMENT (FIRST) 22.SIGNATURE

23. VERIFICATION TYPE

DAY

YEAR

24. DATE PLACEMENT VERIFIED
MO
DAY
YEAR

25. JOB, SCHOOL, MILITARY OR NOT PLACED INFORMATION (SECOND)
A. ONET SOC

B. TPA

C. Hours

D. Hourly Wage

E. Job Title

26. EMPLOYER, SCHOOL OR INSTITUTIONAL TRAINING PROGRAM (SECOND)
A. Name
D. Area Code & Phone No.
B. Number and Street Address

E. Fax No.

F. JTM
27. NON-PLACER

F. Email

Was Student
Placed By NTC?

G. Web Site

C. City, State, ZIP Code

28. PLACEMENT VERIFICATION (SECOND)
A. CONFIRMATION OF PLACEMENT / SELF - EMPLOYMENT STATUS
Name
Title

Phone No.

C. DATE STUDENT REPORTED
MO
DAY
YEAR
D. DATE STUDENT PLACED

B. OTHER/COMMENTS

MO

29. NAME AND TITLE OF OFFICIAL VERIFYING PLACEMENT (SECOND)

30.SIGNATURE

US DEPARTMENT OF LABOR - EMPLOYMENT AND TRAINING ADMINISTRATION

DAY

YEAR

31. VERIFICATION TYPE 32. DATE PLACEMENT VERIFIED
MO
YEAR
DAY

ETA-678 (R -01/2007)

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Job Corps Placement Record

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