Form ETA 678 ETA 678 Job Corps Placement Record

Career Transition System

U.S. Department of Labor

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

Expiration Date: xx/xx/xxxx

JOB CORPS PLACEMENT RECORD

1. STUDENT ID	2A. LAST NAME	2B. FIRST NAME	2C. MI	3. SEX	4A. 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	9. ACADEMIC ATTAINMENT:	10. CTT COMPLETION	11.SEPARATION STATUS
MO DAY YEAR	MO DAY YEAR

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

13.STUDENT’S PLACEMENT STATUS			14. CTS AGENCY:	15. CTS CODE:
PLACEMENT STATUS: NON PLACED STATUS:
One Full Time Job	College	Not Placed - Not Seeking Placement	16. PLACEMENT TYPE:
Two Full Time Jobs	Registered Apprentice Full Time Job	Not Placed - Seeking Placement
One Part Time Job	Other Training Program	Not Placed - Reentered Job Corps
Two Part Time Jobs	OJT/Paid Employment	Not Placed - Family Obligations
Armed Forces	Post-Secondary School/Training	Not Placed - Other Reasons
Full Time Job/College Combo	High School Diploma (HSD) Program	Not Placed - Referred to One-Stop Center
Part Time Job/College Combo	High School Equivalency (HSE) Program	Not Placed - Cannot Locate

17. FIRST PLACEMENT INFORMATION: JOB, SCHOOL, MILITARY
A. Registered Apprenticeship	B. ONET SOC Code	C. TPA for Job	D. Hours / Credits / Duration	E. Hourly Wage	F. Job Title	G. Job Description	H. JTM

18. FIRST PLACEMENT INFORMATION: EMPLOYER, SCHOOL, OR INSTITUTIONAL TRAINING PROGRAM				19. STUDENT PLACED BY:
A. Employer or Institution Name	B. POC Name	C. Email	D. Phone
E. Employer’s or Institution’s Address			F. Fax No.
G. Staffing Agency Name	H. POC Name	I. Email	J. Phone	20. ADVANCED CAREER TRAINING (ACT)
				Did ACT student continue in college?
K. Staffing Agency Address			L. Fax No.

21. FIRST PLACEMENT INFORMATION: VERIFICATION
A. CONFIRMATION OF PLACEMENT				C. DATE STUDENT REPORTED
Placement Agency Name	POC Name	Title	Phone	MO	DAY	YEAR
B. OTHER/COMMENTS				D. DATE STUDENT PLACED
				MO	DAY	YEAR

22. NAME AND TITLE OF OFFICIAL VERIFYING FIRST PLACEMENT	23. SIGNATURE	24. VERIFICATION DOCUMENTATION UPLOADED	25. DATE PLACEMENT VERIFIED
			MO	DAY	YEAR

)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. Job Description	G. JTM

27. SECOND PLACEMENT INFORMATION: EMPLOYER, SCHOOL, OR INSTITUTIONAL TRAINING PROGRAM				27. NON-PLACER28. STUDENT PLACED BY:
A. Employer of Institution Name	B. POC Name	C. Email	D. Phone
E. Employer’s or Institution’s Address			F. Fax No.
G. Staffing Agency Name	H. POC Name	I. Email	J. Phone
K. Staffing Agency Address			L. Fax No.

29. SECOND PLACEMENT INFORMATION: VERFICATION
A. CONFIRMATION OF PLACEMENT STATUS				C. DATE STUDENT REPORTED
Placement Agency Name	POC Name	Title	Phone	MO	DAY	YEAR
B. OTHER/COMMENTS				D. DATE STUDENT PLACED
				MO	DAY	YEAR

30. NAME AND TITLE OF OFFICIAL VERIFYING SECOND PLACEMENT	31. SIGNATURE	32. VERIFICATION DOCUMENTATION UPLOADED	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