WIOA Form

WIOA Funding

Step 1 of 5

GRIEVANCE
As an applicant for, or participant in, the Workforce Innovation and Opportunity Act program(s), you have the right to file a grievance if you feel there has been a violation of the implementation of the Act(s), the regulations, the grant, or any other agreements under the Act(s); if you feel you have been discriminated against on the basis of: race, color, religion, sex(including pregnancy, childbirth and related medical conditions, sex stereotyping, transgender status and gender identity), national origin (including limited English proficiency), age, disability or political affiliation or belief, or if you feel there has been fraud, criminal abuse or other criminal activity. If you would like to discuss a complaint, please the WorkOne Center in your county in which the incident occured. If you complaint is not resolved to your satisfaction within three(3) working days, you will be referred to the Equal Opportunity Officer. The EO Officer will assist you with the subsequent steps of the process. A complete copy of the Grievance Procedure is available upon request.
EQUAL OPPORTUNITY IS THE LAW
It is against the law for this recipient of Federal financial assistance to discriminate on the following bases: Against any individual in the United States, on the basis of race, color, religion, sex (including pregnancy, childbirth, and related medical conditions, sex stereotyping, transgender status, and gender identity), national origin (including limited English proficiency, age, disability, or political affiliation or belief, or against any beneficiary of, applicant to, or paticipant in programs financially assisted under the Title I of the Workforce Innovation and Opportunity Act, on the basis of the individuals citizenship status or participation in any WIOA Title I financially assisted program or activity. The recipient must not discriminate in any of the following areas: Deciding who will be admitted, or have access, to any WIOA Title I 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. Recipients of federal financial assistance must take reasonable steps to ensure that communications with individuals with disabilities are effective as communications with others. This means that, uponm request and at no cost to the individual, recipients are required to provide appropriate auxiliary aids and services to qualified with others. This means that, upon request and at no cost to the individual, recipients are required to provide appropriate auxiliary aids and services to qualified individuals with disabilities.
What To Do If You Believe You Have Experienced Discrimination
If you think that you have been subjected to discrimination under the WIOA Title I-financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with either: Cindy Gosser, Equal Opportunity Officer - Interlocal Association (DBA - Workone), 836 South State Street, Greenfield, IN 46140 or electronically at cgosser@workonecentral.org; or by phone at 317-467-0248 x303; or the Hearing Impaired Relay Service (TDD/TTY) is available at 800-743-3333. OR Director, Civil Rights Center (CRC), U.S. Department of Labor, 200 Constitution Avenue NW, Room N-4123, Washington, DC 20210 or electronically as directed on the CRC website at www.dol.gov/crc If you file your complaint with Interlocal Association (IA), you must wait either until IA issues a written Notice of Final Action, or until 90 days have passed (whichever is sooner), before filing with the Civil Rights Center (see address above). If IA does not give you a written Notice of Final Action within 90 days of the day on which you filed your complaint, you may file a complaint with CRC before receiving that Notice. However, you must file your CRC compalint within 30 days of the 90-day deadline (in other words, within 120 days after the day on which you filed your complaint with IA. If IA does give you a written Notice of Final Action on your complaint, but you are dissatisfied with the decision or resolution, you may file a complaint with CRC. You must file your CRC complaint within 30 days of the date on which you received the Notice of Final Action. By signing below, you acknowledge your right to file a grievance has been explained, a summary of the procedures has been given to you, and a complete copy of the process has been made available to you.
Applicant Signature
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Signature of parent or guardian if applicable
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WorkOne Staff Signature
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WIOA Funding

Step 1 of 5

Contact Information

Demographic Information

Veteran Information

Employment Information

Work History

Dislocated Worker (laid off no fault of your own in the past 3 years)

Education Information

Public Assistance

Barriers

Family Income

Applicant Certification Statement: (Not to be signed and dated until all documentation has been provided)

GRIEVANCE

EQUAL OPPORTUNITY IS THE LAW

What To Do If You Believe You Have Experienced Discrimination

Disabilities

Wayne Township Adult Education Portal