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Virginia SkillBridge Program- Employer Application

Virginia Department of Veteran Services (VDVS) and identified community partners have collaborated to facilitate SkillBridge internship connections for transitioning Service members who are separating or retiring from the military. SkillBridge authorization allows eligible Service members with command approval to participate in corporate internships as their place of duty up to 180 days prior to separation. This program is recognized by the Department of Defense as an approved SkillBridge Program, all individuals from all Service branches are invited to participate.

Internship Programs – An internship is a workplace learning experience that assists participants to prepare for employment by observing and performing, within the employer’s operating environment, the work activities performed by members of the employer’s workforce. Internships may be completed in Federal, State, or local government or in the private sector (either for-profit or not-for -profit).

**All fields may not be required and my not apply to your organization, please leave these fields blank.

Please provide the name, position, phone number, and email address of the person responsible for completing this form:

Employer Enrollment Form

First Name*

Last Name*

Phone*

Organization Name*

Organization Email Address*

Position*

Address*

Address City*

Address State*

Address Zip*

What is the delivery method (select one)*

Will the program delivery be on-base or off-base?*

Please specify the base(s) and/or city and state*

What is the duration of the Fellowship program?*

Will the fellowship require the G.I. Bill?*

If so, which program(s) will be utilized?*

Please list the purpose of the use of DoD Tuition Assistance Funds:*

How much DoD Tuition Assistance is needed?*

Please explain the type of GI Bill benefit to be used:*

How much GI Bill Funds needed?*

Are there additional costs to the service member?*

Please list the type of costs to eligible Service Members (to include but not limited to all resources, tuition, and fees) :*

Indicate the civilian occupation(s) and O’Net Code*

Unable to find O’NET code, enter the job title*

Please select from the following the occupation(s) to which your Fellowship program applies:*

Is your organization a Fortune 1000 company?*

Government partner?*

Is your organization a DoD contractor?*

If so, Is 50% of its revenue from DoD contracts?*

If so, What Services are you supporting?*

How long is your current contract? (if applicable)*

If so, How long has your contract been in place?*

Will DoD funds support fellowship trainee tasks?*

Is it ethical to hire fellowship participants?*

Have you participated in one of the following?*

Which branches of the armed services?*

What additional information would you like the Department of Veterans Services to consider regarding the proposed Fellowship program?*

Please indicate the best characterization of your proposed Fellowship program (select one) :*

In order to participate in Fellowship as an Industry Recognized Apprenticeship or Pre-apprenticeship program, the following criteria must be met. Please check the criteria to which your program adheres:

The Industry Program must train apprentices for employment in jobs that require specialized knowledge and experience and involve the performance of complex tasks.*

The Industry Program has structured work experiences, and appropriate classroom or related instruction adequate to help apprentices achieve proficiency; involves an employment relationship; and provides apprentices progressively advancing industry essential skills..*

The Industry Program provides apprentices employment upon successful completion of the Industry Program..*

The Industry Program provides a safe working environment for apprentices that adheres to all applicable Federal, State, and local safety laws and regulations..*

The Industry Program provides apprentices structured mentorship opportunities to ensure apprentices have additional guidance on the progress of their training and their employability..*

The Industry Program affirms its adherence to all applicable Federal, State, and local laws pertaining to Equal Employment Opportunity (EEO)..*

Participation in an internship is based on strict adherence to all criteria listed below. Please attest to the fact that your proposed Fellowship Internship Program complies with the following criteria (select all that apply):

The Service member participant will receive full military pay and benefits for the duration of the internship and no compensation from the organization sponsoring the internship.*

The Service member will work under the close supervision of the organization’s staff for the duration of the program..*

Facility will not request or permit 40+ hours/week*

The internship adheres to guidance from the Department of Labor Opinion Letter Regarding the DoD SkillBridge Program (refer to DoD Skillbridge Program ):*

The facility must report monthly data regarding internship enrollment and progress. Reporting is due on the 15 th day of each month.*

The facility must notify the Virginia Department of Veteran Services of any changes regarding a trainee’s schedule and/or work agreement. Notifications should occur as soon as reasonably possible..*

Please select which of the following apply to your proposed employment skills or training Fellowship program. The proposed Fellowship program is:

An Education and Job Training Program approved by the U.S. Department of Veterans Affairs (VA). (See the VA ”Search for Approved Education and Job Training Programs” for more information)*

Accredited by American National(ANSI) or ICACE*

Accredited by an accrediting agency recognized by the U.S. Department of Education (DE) (see DE’s database of accredited programs and institutions for more information) .*

A National Association of State Approving Agencies (NASAA) approved Education, Training, license, or Certification Program (see the NASAA Search for Approved Education, Training, License, Certification, and National Exam Programs for more information).*

A training program accredited by the Council on Occupational Education (COE) (see COE’s list of accredited training programs for more information).*

Have you submitted program outline details?*

Please provide details about the opportunity your organization will provide as a Fellowship program. These details must include a written plan (program standards) embodying the terms and conditions of the program, the objective(s) of the opportunity. Additionally, provide a schedule of events, defined tasks, roles and responsibilities for both the Fellowship participant and supervising members of the sponsoring organization and any other relevant related information that supports the objectives of the opportunity.

Please describe the objective of the proposed opportunity:*

Please list any terms and conditions for your proposed Fellowship program:*

Please provide a schedule for your prospective Fellowship program:*

Please provide any additional details about your prospective Fellowship program:

By submitting this form, I attest that the information provided within this form is true and accurate to the best of my knowledge and belief. Additionally, I acknowledge and understand that checking this box will be enforceable as to the extent of a handwritten signature for enforcement / enforceability on documents. I agree, that if there are changes to a trainee’s approved training outline or work agreement, I will make the Virginia Department of Veteran Services aware, immediately.

I agree:*

Training Outline

File(s) size limit is 20MB.

Education, Transition & Employment

Virginia SkillBridge Program- Employer Application