Youth Employment Program Eligibility Application

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Thank you for your interest in the Hamilton County Youth Employment (HCYE) program! Follow these steps to enroll and register for paid training:

  • Complete all fields accurately. Incomplete applications must be restarted and resubmitted.
  • “Additional Eligibility” question: Identify a barrier. If none apply, select “Other” and explain.
  • Final Step: Sign the application.
    • For youth under 18: A parent must sign, and the youth will sign on the first day of training.
    • Ignore the red “VERIFICATION” message, sign, and click “Submit.”

We’re excited to have you join!

Youth Information





If no email, enter noemail@gmail.com in the box.

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You must be between the ages of 14 and 21 to participate in our program.



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You must have your social security number to complete the enrollment process.
Residential Address




Mailing Address




Parent or Guardian Information



If no email, enter noemail@gmail.com in the box.

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Demographics













Additional Eligibility


Acknowledgement
THIS FORM MUST BE COMPLETED & SIGNED BY BOTH YOUTH AND PARENT/GUARDIAN and YOUTH AGE 18 AND OLDER.
Parent Consent Agreement
Minors aged sixteen and seventeen who are to be employed during summer vacation months after the last day of the school term in the spring and before the last day of the school term in the fall, in non- agricultural and non-hazardous employment as defined by the Fair Labor Standards Act of 1938, 52 Stat. 1060, 29 U.S.C.A. 201, and similar state statutes, or in other employment not prohibited to minors age sixteen and seventeen by law, shall not be required to provide an age and schooling certificate as a condition of employment. In order to be hired for employment during summer vacation months, such minors shall provide the employer with the following:

  1. Evidence of proof of age in the same manner as proof of age is provided the superintendent of schools under division C of Section 3331.02 of the Revised Code.
  2. A statement signed by the minor’s parent or guardian consenting to the proposed employment during the summer vacation months. For the purpose of this section, in the absence of a parent or guardian, a person over eighteen years of age with whom the minor resides may sign such statement.

The employer shall retain a copy of the proof of age and the statement of consent with the minor’s employment records.
Proof of Age (Minor must present a copy of proof of age that can be kept with personnel records)
HYCE Collaboration Release
Definition of "Case Information":
If this release authorized the disclosure of Case Information, consent to such disclosure may include the following types of information, if they are in the Hamilton County Youth Employment-HCYE files of the agency disclosing the information:

A. Identifying information: names, birth dates, sex, race, address, telephone number, social security number, type of services being received and name of agency providing services to me or my minor children. Medical Records, including but not limited to results of physical and mental examinations, diagnoses of physical and mental disorders, medication history, physical and mental health status and history, summary of treatment or services received, summary of treatment or services received, summary of treatment plans and treatment needs.

B. Psychological and medical testing, including but not limited to any IQ tests or other tests of cognitive or emotional or mental status, and any reports of physical tests such as x-rays, CT scans, diagnostic blood testing, or other results.

C. All records of services provided by Hamilton County Job and Family Services except child abuse investigation reports. 

To all Agencies receiving information disclosed pursuant to this
If the records released pursuant to this consent include records of any diagnosis or treatment of drug or alcohol abuse, the following statement applies:
Information disclosed pursuant to this consent has been disclosed to you from records whose confidentiality is protected by Federal Law. Federal regulations (42 FR Part 2) prohibit you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is NOT sufficient for this purpose.
I hereby authorize the Member Agencies of Hamilton County Youth Employment Program/Hamilton County Job and Family Services Collaborative, named on the reverse side of this authorization, to exchange information in their records, from whatever source derived, and related to my participation in the services provided by the Youth Employment Program. 

I understand the following:
1. The purpose of this information sharing is to improve the communication about services to me and my family.
2. Each of the member agencies has agreed:
a. to share this information only with other member agencies.
b. not to share this information with non-member agencies without my written consent unless otherwise required or authorized by law; and
c. information exchanged due to this authorization will not be used against me or my children for purposes of criminal
3. Any and all rights to confidentiality which I may have under state or federal law will continue, except for information covered by this form.
4. I may revoke this Authorization at any time except for information that has been previously exchanged.
5. This Authorization shall automatically expire one year from the date below unless I revoke it sooner.
6. This Authorization shall not restrict Information-Sharing otherwise authorized by law.

Case Information: I authorize the sharing of the following information:
  • Identifying information, plus medical and social history, treatment/service history, and other personal
  • information held by any of the member agencies regarding me or my minor children.
  • Substance abuse diagnosis
  • Treatment progress
  • Level of Care / Referral / Authorization
Staff person facilitating this authorization information regarding HIV and AIDS related diagnosis will require a separate release form and cannot be released by using this release form.

If Yes:
This authorization for information sharing has been explained to me. I have read the disclosures below. I have been given a reasonable amount of time to ask questions and consider whether to permit sharing of this information. I hereby willingly agree to the sharing of information as described above

If No:
I refuse to allow my case information to be exchanged. I understand that my signing or refusing to sign this authorization will not affect public benefits or services that I am otherwise entitled to.

Emergency Data Sheet




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Media Release
I have decided of my own accord to be interviewed, photographed and/or quoted for Talbert House, Community Action Agency publicity and or media use. Talbert House and Community Action Agency are not responsible for my decision to do so, and I hold Talbert House and Community Action Agency, harmless in this matter.
Hamilton County and the City of Cincinnati WIOA Summary of Complaint Rights
WIOA complaint procedures are for program applicants/registrants, participants, Local Workforce Innovation and Opportunity Areas (LWIOAs) and their subrecipients/providers, labor unions/joint labor/management committees, community-based organizations or any individual or organization wishing to file a WIOA-based complaint. Complaints must be reduced to writing. They may be filed by mail (regular or electronic) or in person by the Complainant or his/her authorized representative.
Programmatic Complaints
LWIOA 13 Grant Recipient Level:

Persons who wish to file programmatic complaints have ONE YEAR from the date of the incident or alleged unfair treatment to do so. It is recommended, however, that a complaint be filed within TEN (10) DAYS of the incident/treatment. The Equal Opportunity Officer shall be available to provide assistance to the Complainant.
WITHIN TEN (10) CALENDAR DAYS of the filing of the complaint, an INFORMAL CONFERENCE will be held to attempt resolution of the complaint. If no resolution is reached, the Complainant will be given written notice of his/her right to REQUEST A HEARING.

WITHIN SIXTEEN (16) CALENDAR DAYS from the date the complaint was filed, the Complainant must provide a written REQUEST FOR HEARING. If any amendment(s) to the original complaint are needed, they must also be submitted, in writing, with the REQUEST FOR HEARING.

WITHIN THIRTY (30) CALENDAR DAYS of the filing of the complaint, a HEARING WILL BE CONDUCTED. The Complainant and Respondent shall be advised, in writing, of all procedural rights. (i.e., representation, presentation of evidence, witnesses, etc.)

WITHIN SIXTY (60) CALENDAR DAYS of the filing of the complaint, a written decision shall be rendered by the Hearing Officer. The decision shall be mailed to the parties (Complainant and Respondent) by certified mail, return receipt requested. The decision shall include, but not necessarily be limited to the following:
(1) The reason(s) for the decision;
(2) A statement as to whether LWIOA complaint procedures have been complied with; and,
(3) Notice of the right to request a review at the State Recipient Level (Ohio Department of Job and Family Services, Bureau of Civil Rights) when any party disagrees with any aspect of the local Hearing Officer’s decision.

State Recipient Level Review:

Any party has TEN (10) CALENDAR DAYS from the date of receipt of the local Hearing Officer’s decision or FIFTEEN (15) CALENDAR DAYS from the date on which the decision should have been received to request a review with the Ohio Department of Job and Family Services’ Bureau of Civil Rights,150 E. Gay Street, 18th floor, Columbus, Ohio 43215-3130. The Bureau of Civil Rights reviewer may uphold the local level decision, in whole or in part, or may provide a hearing and final written decision within THIRTY (30) CALENDAR DAYS of the date of receipt of the request for review. Pursuant to the WIOA regulations, this decision exhausts administrative remedies at the State Recipient Level.

If the results of the State Recipient Level Review have not been provided to both parties within THIRTY (30) CALENDAR DAYS of the request for review, or if either party is dissatisfied with the results of the review, a complaint may be filed with the Secretary, U. S. Department of Labor, Washington, DC 20210, ATTN: Assistant Secretary for Employment and Training (ASET).
Discrimination Complaints
Any person who believes that he/she has been subjected to unlawful discrimination may file a complaint. It is unlawful for WIOA-funded programs to discriminate against any person or class of individuals because of race, color, religion, national origin, sex, political affiliation or belief, age, disability or (for beneficiaries only) citizenship status, as a lawfully admitted immigrant, authorized to work in the United States. It is also unlawful to discriminate against individuals on the basis of their WIOA participant status.

A complaint must be filed within 180 DAYS of any alleged discriminatory act or treatment. Only the Director of the USDOL Civil Rights Center, for good cause shown, may extend the filing time limit.

Discrimination complaints may be filed in the following ways:
  • A complaint may be filed with the Ohio Department of Job and Family Services’ Bureau of Civil Rights. The Bureau is located at 150 East Gay Street, 18th floor, Columbus, Ohio 43215-3130, toll-free phone: 1-866-BCR-ODJF (227-6353). BCR will conduct an investigation of the complaint and issue its Notice of Final Action within NINETY (90) DAYS of receipt of the complaint, with applicable appeal rights. The LWIOA Equal Opportunity Officer shall provide assistance to the Complainant, as needed. or 
  • A complaint may be filed directly with the U. S. Department of Labor, Civil Rights Center. CRC is located at 200 Constitution Avenue, N. W., Room N-4123, Washington, DC, 20210. Their phone number is: (202) 693-6500. If the Complainant chooses the federal process, the complaint is to be sent directly to the Civil Rights Center.

Complainants shall be offered a choice of having their allegations addressed through the customary investigative process or through Alternative Dispute Resolution (ADR). More information on this is available from the ODJFS Bureau of Civil Rights.
Fraud, Abuse or Criminal Activity
All information and/or complaints alleging program fraud, abuse or criminal activity are reported directly and immediately to the U. S. Department of Labor, Office of Inspector General, Room S5514, 200 Constitution Avenue N.W., Washington, DC, 20210. The OIG Hotline phone number is: 1-800-347-3756.
Equal Opportunity Is the Law
It is against the law for this recipient to discriminate on the following bases: 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 of programs financially assisted under Title I of the Workforce Innovation and Opportunity Act of 1998 (WIOA), 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 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 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 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 the recipient’s Equal Opportunity Officer (or the person whom the recipient has designated for this purpose); or the Director, Civil Rights Center (CRC), U. S. Department of Labor, 200 Constitution Avenue, NW, Room N-4123,
Washington, DC 20210. If you file your complaint with the recipient, you must wait either until the recipient 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 the recipient does not give you a written Notice of Final Action within 90 days of the day on which you filed your complaint, you do not have to wait for the recipient to issue
that Notice before filing a complaint with CRC. However, you must file your CRC complaint within 30 days of the 90-day deadline (in other words, within 120 days after the day on which you file your complaint with the recipient).If the recipient 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.
If you have questions regarding your rights, you may contact your local Equal Opportunity Officer or the ODJFS Bureau of Civil Rights.
Electronic Payroll Agreement
I agree to the following:
  1. I am required to log clock-in and clock-out times either in Paycom or on an approved timesheet program.
  2. I must clock in and out at the beginning and end of each shift.
  3. I must clock out and in at the beginning and end of a lunch break.
  4. Errors made on my timesheet will be corrected on the next pay period.
  5. My supervisor must approve my timesheet before it is submitted to payroll.
  6. I agree and understand that I will be paid wages in the amount of $13.00 per hour for hours worked for Hamilton County Youth Employment.
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