Form 1 Employment Navigator Intake Form

Employment Navigator Data Collection and Matching

Employment Navigator Intake Form.xlsx

Employment Navigator Intake Form

OMB: 1293-0016

Document [xlsx]
Download: xlsx | pdf
OMB Control Number: 1293-XXXX
Expiration Date: XX/XX/XXXX

Employment Navigator Data Entry Layout
Element Number Element Name Description Valid Values Data Type/Field Length
1 Unique ID Automatically generated field from case management system XXXXXXXXXX AN10
2 Social Security Number The participant's Social Security Number XXXXXXXXX AN9
3 Client Type Enter the correct code value for the participant 1 = Transitioning Service Member
2 = Spouse
3 = Transitioning Service Member (Warm Handover)
IN1
4 Date of First Contact Record the date the participant first contacted an Employment Navigator MMDDYYYY Date8
5 Separation Date Enter the anticipated separation date if in the future, or the actual separation date if in the past. MMDDYYYY Date8
6 Sex Enter the gender of the participant 1 = Male
2 = Female
3 = Other, or did not disclose
IN1
7 Year of Birth Select the year the participant was born YYYY IN4
8 Individual with a Disability (WIOA)

Record 1 if the participant indicates that he/she has any "disability”, as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102). Under that definition, a "disability" is a physical or mental impairment that substantially limits one or more of the person's major life activities.
Record 0 if the participant indicates that he/she does not have a disability that meets the definition.
Record 9 if the participant did not self-identify.

1 = Yes
0 = No
9 = Participant did not self-identify
IN1
9 Highest Education Attained Select the highest level of education attained by the participant at the time of service. 1 = Attained secondary school diploma
2 = Attained a secondary school equivalency
3 = The participant with a disability receives a certificate of attendance/completion as a result of successfully completing an Individualized Education Program (IEP)
4 = Completed one of more years of postsecondary education
5 = Attained a postsecondary technical or vocational certificate (non-degree)
6 = Attained an Associate's degree
7 = Attained a Bachelor's degree
8 = Attained a Masters degree
9 = Attained more than a Masters degree 0 = No Educational Level Completed
IN1
10 Branch of Service Select the military branch in which the participant currently serves, or most recently served. 1 = Air Force
2 = Army
3 = Coast Guard
4 = Marine Corps
5 = Navy
IN1
11 AD/NG/Reserve Status (Last Duty Status) Select the current or most recent duty status of the participant. 1 = Active Duty
2 = National Guard
3 = Reserve
IN1
12 Military Paygrade Select the current or most recent military paygrade of the participant. E-E9; O1-O10; W1-W5 AN3
13 Current Location Installation Select the location in which the participant has received services NS Norfolk, VA
Camp Pendleton, CA
JB Pearl Harbor-Hickam, HI
MCAS Miramar, CA
Fort Benning, GA
Fort Sill, OK
Cherry Point, NC
Travis AFB, CA
MCAB Okinawa, Japan
USAG Bavaria, Germany
CFA Yokosuka, Japan
Joint Base Charleston, SC
Kadena AB, Okinawa, Japan
AN50
14 Home State Enter the participant's home state. Home state is defined as the last state resided in before joining the military. Drop-down list of 50 state mailing codes, plus PR, VI, DC. AN2
15 First Name Enter the participant's first name XXXXXXXXXX AN50
16 Last Name Enter the participants last name XXXXXXXXXX AN50
17 Personal Phone Number Enter the phone number of the participant (XXX)XXX-XXXX IN10
18 Personal Email Address Enter the non-military email address of the participant [email protected] AN50
19 Personal Email Address #2 (optional) Enter a second personal email address, if desired [email protected] AN50
20 Preferred Contact Method Enter a value for the preffered method to contact the participant, if necessary. 1 = Call personal phone
2 = Text personal phone
3 = Email address #1
4 = Email address #2

21 Preferred Post-Military Location City1 Enter the most desired city the participant wishes to move to after military transition City AN50
22 Preferred Post-Military Location State1 Enter the most desired state the participant wishes to move to after military transition State AN50
23 Preferred Post-Military Location Country1 Enter the most desired country the participant wishes to move to after military transition Country AN50
24 Preferred Post-Military Location City2 Enter the second-most desired city the participant wishes to move to after military transition City AN50
25 Preferred Post-Military Location State2 Enter the second-most desired state the participant wishes to move to after military transition State AN50
26 Preferred Post-Military Location Country2 Enter the second-most desired country the participant wishes to move to after military transition Country AN50
27 Occupation of Interest Identify the occupation the participant is most interested in pursuing post-transition

AN50
28 Industry of Interest Identify the industry the participant is most interested in pursuing post-transition 1 = Agriculture, Forestry, Fishing and Hunting
2 = Mining, Quarrying, and Oil and Gas Extraction
3 = Utilities
4 = Construction
5 = Manufacturing
6 = Wholesale Trade
7 = Retail Trade
8 = Transportation & Warehousing
9 = Information
10 = Finance & Insurance
11 = Real Estate, Rental, & Leasing
12 = Professional, Scientific, and Technical Services
13 = Management of Companies and Enterprises
14 = Administrative and Support and Waste Management and Remediation Services
15 = Educational Services
16 = Health Care and Social Assistance
17 = Arts, Entertainment, and Recreation
18 = Accomodation and Food Services
19 = Other Services (except Public Administration)
20 = Public Administration
AN50
29 Date Attended Employment Workshop Enter the date the participant attended the TAP Employment Workshop. Leave blank if not atttended. YYYYMMDD Date8
30 Date Attended Career and Credential Exploration (C2E) Workshop Enter the date the participant attended the TAP C2E. Leave blank if not atttended. YYYYMMDD Date8
31 Work Availability Date Enter the date the participant is available to begin work. YYYYMMDD Date8
32 Career Goal Indicate the most desired post-transition goal. 1 = Employment (non-apprenticeship)
2 = Continuing Education
3 = Apprenticeship
4 = Entrepreneurship
5 = Unsure
IN4
33 Career Pathway: Networking Indicate if the participant would benefit from networking exposure as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
34 Career Pathway: Mentorship Indicate if the participant would benefit from mentorship as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
35 Career Pathway: Job Training Indicate if the participant would benefit from job training as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
36 Career Pathway: Job Placement Indicate if the participant would benefit from direct job placement services as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
37 Career Pathway: Apprenticeship Indicate if the participant would benefit from an apprenticeship program as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
38 Career Pathway: Hiring Events Indicate if the participant would benefit from attending a hiring event/fair as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
39 Career Pathway: Wrap-Around Services Indicate if the participant would benefit from any additional supportive services, such as: housing assistance, logistics and transportation, recreation/fitness, child care, financial aid, etc. as part of the career pathway. 1 = Yes, and was referred to a partner entity
2 = Yes, but participant was not interested/refused service
3 = No, would not be beneficial
IN1
40 Services Received: Resume Review Indicate the most recend date that resume review was provided to the participant by an Employment Navigator. Leave blank if not provided. YYYYMMDD Date8
41 Services Received: Skills & Interest Assessment Review Indicate the most recent date that the skills and interest assessment was provided by an Employment Navigator and/or reviewed if previously done. Leave blank if not provided. YYYYMMDD Date8
42 Services Received: Labor Market Information Indicate the most recent date that labor market information was provided by an Employment Navigator to the participant. Leave blank if not provided. YYYYMMDD Date8
43 Services Received: Apprenticeship Overview Indicate the most recent date that information regarding potential apprenticeship opportunities was provided by an Employment Navigator to the participant. Leave blank if not provided. YYYYMMDD Date8
44 Services Received: Application submittal (employer or apprenticeship program) Indicate the most recent date that an application was submitted on behalf of the participant. Leave blank if not provided. YYYYMMDD Date8
45 Not Interested/Refusal Reason If the participant refused any of the above services, record reason for refusal. 1 = Doesn't think this will help them
2 = Cost factor is an issue
3 = Service isn't available in the desired/future location
4 = Doesn't have available time to participate in the service or activity
5 = Not enough information or not ready to make an informed decision
6 = Other

46 Not Interested/Refusal Reason (Other) If data element #XX = 6, please identify the reason as provided by the participant. Insert Text AN50
47 Warm Handover or Connection Type Select the type of entity that was referred to the participant 1= American Job Center (Warm Handover)
2 = Approved DOL Partner (non-AJC)
3 = VA Partner (e.g. benefits counselor)
4= DoD Partner
5 = Education entity
6 = Technical Training
7 = Other
8 = No Warm Handover or Connection
IN1
48 Warm Handover or Connection Entity Select the entity that was referred to the participant (System will generate drop-down choices based on specific partners registered) AN50
49 Employment Navigator Referral Source Select the primary sources of how the participant heard about the Employment Navigator program. Select all that apply. 1 = DOL TAP Courses
2 = Social Media - Facebook
3 = Social Media - LinkedIn
4 = Social Media - Twitter
5 = Email/Text Notification
6 = Word of Mouth
7 = Warm Handover from Commander
8 = American Forces Network / Television
9 = Other
IN8
50 Placed into Employment Indicate if the participant was placed into an employment opportunity as a result of Employment Navigator Services. Do not complete this field if participant is referred to a partner. 1 = Placed into employment
2 = Placed into an Apprenticeship program
3 = Not placed
IN1
51 Placement Location - State Indicate the state in which the participant was placed into employment. XX (state postal code) AN2
52 Placement Location - City If known, indicate the city in which the participant was placed into employment. XXXXXXXX AN50
53 Hourly Wage of Job Placement If the participant was placed into employment or an Apprenticeship program, indicate the starting wages per hour $XXX.XX IN5
54 Other Notes Optional field. Insert any notes on services provided that may assist other Employment Navigators or partners XXXXXXX AN500
55 Case Closed Select the reason for participant case closure. 1 = Closed due to job placement or referral to partner
2 = Closed due to Participant no longer interested
3 = Closed due to participant inactivity of 90 days with no future services scheduled
IN1
56 Future Service Date Select a future date at which the participant will receive additional Employment Navigator services. A value in this field will keep the participant record in 'open' status YYYYMMDD Date8
57 Special Project Identifier Placeholder for any future enhancements to filter out participants based on a set criteria XXXXX AN5
Data Type Codes: AN = Alpha-Numeric; IN = Integer; Number behind code represents the overall length allowable for the field.








According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 0.25 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, 200 Constitution Ave., NW, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1293-0NEW.
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