P.O. Box 615Bldg. 647, King Salmon AFB

King Salmon, AK 99613

Phone: (907) 246-4600Fax: (907) 246-4607

Web: W\\\\ .savec.orgSouthwest Raska Vocctionci e EdJcction CerrerI ralrln<;:~rlo'>kar.", 10 r,l nac;kon J()b~

December 16, 2010

Dear Applicants:

We are pleased that you have decided to take the next step to a unique careeropportunity with CH2M Hill. We anticipate large volumes of applications. Thus, yourapplication packet must be complete in order to be considered for this trainingopportunity. All application materials and requested documents "must" besubmitted to SAVEC by 5:00 p.m., January 19th

, 2011. Class dates are to bedetermined soon. A complete application packet consists of the following:

1. 2011 STEP Grant Application.2. SAVEC Work History Application.3. Resume and Letter of Interest.4. Letter of Recommendation.5. Copy of current Alaska Driver's License.6. Alaska Request for Driving Record.

- Complete information requested, sign, and submit to: SAVEC.To speed the effort, we encourage all applicants to obtain their own drivingrecord from their local Alaska Department of Motor Vehicles (DMV) officeand submit to SAVEC.

7. Copy of high school transcript or GED transcript.8. Copy of W-2 (statement must be within the last 3 years) or recent pay stub.

Should you have any questions concerning the forms, please feel free to contact usat (907) 246-4600, Monday - Friday, 8 00 a.m. to 5. p.m. or email Becky Savo atbecky@savec.org

We wish you the best and please feel free to call us should you have anyquestions.

Sincerely,

~~a~Administrative Assistant

State Training and Employment Program Application (STEP)

STATE OF ALASKA

Equal Opportunity Employer/ProgramAuxiliary aids and services are available upon request to individuals with disabilities.PRINT CLEARLY

PARTICIPANT INFORMATION CONTACT INFORMATION

Social Security # Provide contact information for someone who usuallyknows how to contact you, even if you move.

Last Name: Last Name:

First Name: Middle First Name: Middle Initial:Initial:

Street Address: Street Address: (Only if different from above)

Mailing Address: (Only if different from above) City:

Zip Code: State: Alaska

City: Zip Code:

State: Contact Phone:

Home Phone: Participant Message Phone Number (if Applicable):

Election (Hse/Sen) District Code: Participant Work Phone Number (if Applicable):

E-Mail Address: Relationship to Participant:

The following questions are for data collection only and are not used for determining eligibility

Date of Birth: Are you Hispanic or Latino? Race please check all that applyMonth Day Year (Check one) 0 White o American Indian

0 Yes 0 No 0 Asian o Alaska Native/ / 0 Black/ African o Hawaiian Native

Gender: Alaska resident within the last 30 Are you a veteran?

0 Male o Female days? 0 Yes, Over 180 Days0 Yes 0 No 0 Yes, Under 180 Days

Do you need job skills training to Do you risk losing your job due a 0 Yes, Other Eligible Personbecome or remain a self-sufficient downturn in the economy?

0wage earner? DYes o NoNo

0 Yes o No

Are you able to perform the essential functions of this job or training program, with or without reasonableaccommodation?

0 Yes 0 No

Page 1 of 2 Revised: September 10, 2010

State Training and Employment Program Application (STEP)

(Eligibility Code) Check the circumstance that applies to you (check only one):

Unemployedo 01 I am unemployed and receiving Unemployment Insurance (U. I.) benefits.

o 02 I am unemployed and have contributed to U. I. within the last 5 years.

Employed, Employer must provide verificationo 03 I am employed but likely to be displaced because of reduction in overall employment within thebusiness.

o 04 I am employed but likely to be displaced because of the elimination of my current job.

o 05 I am employed but likely to be displaced because of a change in condition of employmentrequiring that to remain employed, I must learn substantially different skills than what Icurrently possess.

OR

o 06 I am in need of training to improve the prospects for obtaining or retaining employment.Employer verification is required for 06, when the employment goal is to receive a promotion with current employer.

Applicant Certification

I certify to the best of my knowledge the information in this application is accurate, true, and verifiable. I understandthat falsification of information to receive grant benefits may be grounds for removal from the program, and/or I mayhave to repay benefits received, and/or legal action may be brought against me. I certify that I cannot pay for thetraining I need to gain or remain gainfully employed without incurring financial hardship upon myself and/or my family.I certify that I have lived in Alaska continuously for more than thirty days and I intend to stay in Alaska and make it myhome. I understand that there is a grievance procedure available that explains how I can appeal all eligibility decisionsmade with regard to this application for STEP program services. I further agree to the use of my Social SecurityNumber if reflected on the first page.I hereby certify that I have been provided a copy of the Equal Opportunity Is the Law Notice, have read and understandthe contents of this document.Applicant's Signature Date:

OFFICE USE ONLY (must be completed and signed at the time of eligibility determination)Eligibility Determination Date:Registration Date:Grantee/Contractor Name:

Justification for using STEP funds (check at least one): Applicant is a resident and:

o Satisfies requirements specified in the respective grant agreement.

Grantee Signature: Date:

Page 2of2 Revised: September 10, 2010

Rev4-10

CERTIFICATION FORM

Equal Opportunity Is the Law

It is against the law for this recipient of state financial assistance to discriminate on the followingbasis:• Against any individual in the United States, on the basis of race, color, religion, sex, national

origin, age, disability, political affiliation or belief; and• Against any beneficiary on the basis of the beneficiary's citizenship! status as a lawfully admitted

immigrant authorized to work in the United States, or his or her participation in any statefinancial assistance program or activity.

The recipient must not discriminate in any of the following areas.• Deciding who will be admitted, or have access, to any state financially assisted program or

activity;• Providing opportunities in, or treating any person with regard to such a program, or activity, or,• Making employment decisions in the administration of, or in connection with, such a program

or activity.

What to Do If You Believe You Have Experienced Discrimination

If you think that you have been subjected to discrimination under a state financially assisted programor activity, you may file a complaint within 180 days from the date of the alleged violation with:

The state Department of Labor and Workforce Development Equal Opportunity Officer:• Louise Dean, at 1016 West 6th Avenue, Suite 105, Anchorage, Alaska 99501-1963, or at

telephone (907) 269-7487, or e-mail to louise.dean@alaska.gov.

I hereby certify that I have read and understand the content of this document.

DATEAPPLICANfjEMPLOYEE SIGNATURE

This is an equal opportunity employer/program.Auxiliary aides and services are available upon request to individuals with disabilities.

SAVECSTEP File 11-629Original Agreement

Attachment EPage Lof S

SoUhwest Aaska Vocctiond e EdJcction eerterIrc..-lg (l(74<<Yl'!-. to r. ~crl Job ...

Training ApplicationApplicant Information

Full Name: Date: _Last First M.I.

Address:Street Address Apartment/Unit #

City State ZIP Code

Phone: E-mail Address:

Date Available: Social Security No.:

Training Session: General Maintenance TechnicianYES NO

Are you a citizen of the United States? 0 0 If no, are you authorized to work in the U.S.?YES NO

Do you have a current Drivers License? 0 0Have you ever been convicted of a criminaloffense or have any pending criminal cases YES NO

other than minor traffic violations? 0 0

YESo NOo

If yes, explain:

Education

High School: Address:YES NO

From: To: Did you graduate? 0 0 Degree:

College: Address:YES NO

From: To: Did you graduate? 0 0 Degree:

Other: Address:YES NO

GED: To: Did you complete? 0 0References

Please list three professional references.

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Full Name: Relationship:

Company: Phone:

Address:

Previous/Cu rrent Employment

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:YES NO

May we contact your previous supervisor for a reference? 0 0

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:YES NO

May we contact your previous supervisor for a reference? 0 0

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary: $ Ending Salary: $

Responsibilities:

From: To: Reason for Leaving:YES NO

May we contact your previous supervisor for a reference? 0 0Military Service

Branch: From: To:

Rank at Discharge: Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interviewmay result in my release.

Signature: Date:

State of AlaskaGED Transcripts

Official Release of InformationONLY FOR THOSE HO A E TA THE GED

(please print until you sign your name at the bottom.)

1 _give permission to the State of Alaska's Adult Basic Education Program to release myGED transcripts.

The name I tested under was --------------------------------------The year I earned my GED was _

The Alaskan town I took the GED test in was -----------------------------My date of birth is _

My social security number is _

The address I wish to have transcripts faxed to: 246-4607

Southwest Alaska Vocational & Education CenterAttention: Becky SavoP.O. Box 615King Salmon, Alaska 99613

Signature Date----------------------------------- ------------------

Fax this completed form to:Department of LaborAdult Basic EducationDonna Collins, Education Associate IP.O. Box 115509Juneau, Alaska 99811-5509Phone: (907) 465-4685Fax: (907) 465-4186 email ged@alaska.gov

• Copies of GED transcripts from the State of Alaska are free.• Duplicate diplomas are $10. Send a money order or check made out to the State of

Alaska for $10 if you wish to have a duplicate diploma made.

STATE OF ALASKA

REQUEST FOR DRIVING RECORD

Driving records are valid for 30 days.

I am requesting the following:

Driving Record (5 year 1 Insurance) ~ Driving Record (Full)

I would like the record to be mailed OrB(circie one) to the address or fax number shown below.

Your name, as shown on your Alaska license _

Your signature _

Telephone _

Mailing address _

ALASKA Driver License Number Date of Birth Social Security NumberOR AND

Purpose of record: _---_\..::....:.V-----!::Q~l~\....!.~....!.!..'t....:.\'""~o;;_----------------------2J

Please complete the following when requesting information via fax. If your request is made by mail,include a check or money order payable to State of Alaska or DMV.

MasterCard or Visa # --------------- Expiration Date _

Visa Security Code (3-digit number on back of card) _

Nameasshownoncard _

I understand that my credit card shown above will be charged $10.00 for each drivingrecord requested.

Signature _(Signature of credit card holder.)

Date _

FAX: 1-907-269-5202 MAIL: Division of Motor VehiclesATTN: RESEARCH1300 W. Benson Boulevard,Suite 200Anchorage AK 99503-3600

DMVUSE ONLY

$10BATCH AMVC ID OFFICE FEE: CA CC CK

Form419F Rev. 01/27/2009 www.Alaska.gov/dmv

Southwest Alaska Vocational e Education CenterTraining Alaskans to FillAlaskan Jobs

APPLICATION CHECK LIST

2011 STEP APPLICATIO

SAVEC WORK HISTORY APPLICATION

Resume

Letter of Interest

Letter of Recommendation

__ Copy of valid Alaska Driver's License

__ Driving Record Request submitted by applicant to DMV(This will be faxed to SAVEC from DMV)

__ Copy of High School Transcripts (or OED)

__ Copy ofW-2 Statement (current to last 3 years) or recent pay check stub(pay check stub must show Employer Name, address, employee name and date)