ETA 678 - Job Corps Placement Record (track changes)

Career Transition System

U.S. Department of Labor

Employment and Training Administration OMB Approval No.: 1205-0035

Expiration Date: 3/31/2017

JOB CORPS PLACEMENT RECORD

1. STUDENT ID	2A. LAST NAME	2B. FIRST NAME	2C. MI	3. SEX	4A. PHONE NO.HOME PHONE

4B. CELL PHONE	4C. ALTERNATE PHONE	5A. STREET ADDRESS, CITY, STATE, ZIPCODE	5B. PERSONAL EMAIL

6. SEPARATION DATE	7. DATE OF BIRTH	8. CENTER CODE	9. ASGNACADEMIC ATTAINMENT:	10. GEDCTT COMPLETION	11.COMPLETIONSEPARATION STATUS
MO DAY YEAR	MO DAY YEAR

13. STUDENT’S CTT TRAINING12. STUDENT’S CAREER TECHNICAL TRAINING (CTT)
A. E-TAR CODE	B. CTT PROGRAM TITLE	C. TRAINING PROGRAM AREA (TPA)	D. TRAINING PROVIDER

14.STUDENT’S PLACEMENT STATUS ON DATE THIS FORM COMPLETED13.STUDENT’S PLACEMENT STATUS			14. CTS AGENCY:	15. CTS CODE:
PLACEMENT STATUS: NON PLACED STATUS:
01 One Full Time Job	10 College	16 NPNot Placed - Not Seeking Placement	16. INITIAL PLACEMENT TYPE:
02 Two Full Time Jobs	Registered Apprentice Full Time Job	15 NPNot Placed - Seeking Placement
03 One Part Time Job	12 Other Training Program	14 NPNot Placed - Reentered Job Corps
04 Two Part Time Jobs	11 OJT/SubsidizedPaid Employment	13 NPNot Placed - Family Obligations
05 Armed Forces	09 Post-Secondary School/Training	18 NPNot Placed - Other Reasons
06 Full Time Job/College Combo	High School Diploma (HSD) Program	21 NPNot Placed - Referred to One-Stop Center
07 Part Time Job/College Combo	08 High School / GEDHigh School Equivalency (HSE) Program	17 NPNot Placed - Cannot Locate

17. FIRST PLACEMENT INFORMATION: JOB, SCHOOL, MILITARY OR NOT PLACED INFORMATION (FIRST)
A. Registered Apprenticeship	B. ONET SOC Code	C. TPA for Job	D. Hours / Credits / Duration	E. Hourly Wage	F. Job Title	G. JTMJob Description	H. JTM

18. FIRST PLACEMENT INFORMATION: EMPLOYER, SCHOOL, OR INSTITUTIONAL TRAINING PROGRAM (FIRST)				19. NON-PLACERSTUDENT PLACED BY: Was Student Placed by NTC?
A. Employer or Institution Name	B. POC Name	F.C. Email	D. Area Code & Phone No.
B, Number and StreetE. Employer’s or Institution’s Address			E.F. Fax No.
G. Web SiteStaffing Agency Name	H. POC Name	F.I. Email	J. Phone	20. ADVANCED CAREER TRAINING (ACT)
				Did ACT student continue in college?
K. Staffing Agency Address			L. Fax No.

20. PLACEMENT VERIFICATION (FIRST)21. FIRST PLACEMENT INFORMATION: VERIFICATION
A. CONFIRMATION OF PLACEMENT / SELF - EMPLOYMENT STATUS				C. DATE STUDENT REPORTED
Placement Agency Name	POC Name	Title	Phone No.	MO	DAY	YEAR
B. OTHER/COMMENTS				D. DATE STUDENT PLACED
				MO	DAY	YEAR

21.22. NAME AND TITLE OF OFFICIAL VERIFYING PLACEMENT (FIRST)FIRST PLACEMENT	22.23. SIGNATURE	23.24. VERIFICATION TYPE DOCUMENTATION UPLOADED	24.25. DATE PLACEMENT VERIFIED
			MO	DAY	YEAR

25. JOB, SCHOOL, MILITARY OR NOT PLACED INFORMATION (SECOND)26. SECOND PLACEMENT INFORMATION: SECOND FULL-TIME / PART-TIME JOB or JOB/SCHOOL COMBINATION PLACEMENT
A. ONET SOC	B. TPA for Job	C. Hours / Credits	D. Hourly Wage	E. Job Title	F. JTMJob Description	G. JTM

26.27. SECOND PLACEMENT INFORMATION: EMPLOYER, SCHOOL, OR INSTITUTIONAL TRAINING PROGRAM (SECOND)				27. NON-PLACER28. STUDENT PLACED BY:
A. Employer of Institution Name	B. POC Name	F.C. Email	D. Area Code & Phone No.	Was Student Placed by NTC?
B. Number and StreetE. Employer’s or Institution’s Address			E.F. Fax No.
G. Web SiteStaffing Agency Name	H. POC Name	I. Email	J. Phone
K. Staffing Agency Address			L. Fax No.

28.29. SECOND PLACEMENT INFORMATION: VERFICATION (SECOND)
A. CONFIRMATION OF PLACEMENT / SELF - EMPLOYMENT STATUS				C. DATE STUDENT REPORTED
Placement Agency Name	POC Name	Title	Phone No.	MO	DAY	YEAR
B. OTHER/COMMENTS				D. DATE STUDENT PLACED
				MO	DAY	YEAR

29.30. NAME AND TITLE OF OFFICIAL VERIFYING SECOND PLACEMENT (SECOND)	30.31. SIGNATURE	31.32. VERIFICATION TYPEVERIFICATION DOCUMENTATION UPLOADED	32.33. DATE PLACEMENT VERIFIED
			MO	DAY	YEAR

34. APPROVING PLACEMENT		35. DATE PLACEMENT APPROVED
A. NAME AND TITLE OF OFFICIAL APPROVING PLACEMENT	B. SIGNATURE	MO	DAY	YEAR

Paperwork Reduction Act Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information, which is required to obtain of retain benefits (29 USC 3199), is estimated to average 7.43 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Room N-4456, 200 Constitution Avenue, NW, Washington, DC 20210, (Paperwork Reduction Project 1205-0035).

ETA FORM 678 (Rev 3/17) Page 4 of 4