Employment Verification Form

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Title IV-E
Payback
Part-Time Students
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Employment Payback Requirements (slide 3)
Verifying & Tracking Employment (slides 4-5)
Job Search Requirements (if applicable) (slides 6-12)
Job Search Support (slide 9)
Job Search Reporting (slides 10-12)
Special Circumstances (slides 13-19)
CalSWEC Petitions & Appeals Processes (slide 15)
Changing Employment (slide 17)
Time off (slide 18)
Monetary Payback (slide 19)
BSW or MSW Pathway
Part-Time Student
MSW
3-Year Part-Time Student
Student must fulfill a work commitment
of 6 months for every 15 units of
support provided.
Student must fulfill a 2-year work
commitment.
Within 6 months of graduation student must return to work at
Public Child Welfare or tribal agency (if employee).
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The first business day after graduation is the
start date for working off your employment
payback obligation.
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In order for us to track your employment payback
progress, print out the Employment Verification
Form:
• You complete Part A
• Your HR completes Part B and keeps a copy in their file
• Mail the original back to the IV-E office:
CSU, Chico
School of Social Work
Title IV-E Program
c/o Melissa Cheatham
400 West First Street
Chico, CA 95929-0550
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This form will serve as a consent for release of
information so we can communicate with your
HR about your employment status.
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We check your employment status directly with
your HR every 6 months until your employment
payback is complete.
• We will contact you and/or your employer during your payback
period to verify that you are fulfilling the work requirement
• (6 months of continuous full-time employment for every 15 units of support
provided for Pathway students or 2 years of continuous full-time employment for
MSW three-year students)
• We submit information and updates about your employment status to
CalSWEC
• We calculate your payback progress and project a completion date
based on what your HR reports to us regarding your employment
• If there are interruptions in your employment (unpaid medical leave,
maternity leave, etc.) we recalculate your completion date
accordingly
Should you need to search for new qualifying employment…
• Within the first 6 months of employment search, you are
required to search only within 75 miles of your home address
• Must apply to every open position (and participate in all tests and
interviews) at a level appropriate to a new worker in Child Welfare, and
accept the first position offered to you
• If unable to secure employment within 6 months and within a
75-mile radius, you must extend your search statewide for 6
months
• Must apply to every open position (and participate in all tests and
interviews) at a level appropriate to a new worker in Child Welfare, and
accept the first position offered to you
• If you are still unable to secure employment within these 12 months after
beginning your job search, you must then request a waiver and provide
satisfactory documentation of a comprehensive employment search, in order
to receive permission to seek employment in a nonprofit agency serving IV-E
clients (see Petitions and Appeals Process section)
• If approved, you will receive an additional 6 months to search for employment.
• After graduation or when you begin a new search (due to job loss, etc.) you
must report your job search status using the Title IV-E Graduate
Employment Search Form once monthly until you secure employment (see
Job Search Reporting section)
• To demonstrate an adequate search, you must have had applied to all
available jobs at a level appropriate to a new worker in Child Welfare in
your 75-mile radius (or statewide)
Within six (6) months of
graduation and/or
beginning new job search
Within six (6) to twelve
(12) months of graduation
and/or beginning new job
search
Must return to work at
agency (if employee)
Search for employment
within the state of
California.
OR
Search for qualifying work
within a 75 mile radius of
Student’s home
Within twelve (12) to
eighteen (18) months of
graduation and/or
beginning new job search
If waiver is granted to
search for employment at
non-profit agencies, Student
may have up to 6 months to
If, within 12 months, Student do this search.
does not secure
employment within the
If Student does not secure
state, Student may apply
employment during this
for a waiver to search for
time, Student may apply for
employment in a non-profit a waiver of employment
agency within the state.
obligation requirements at
18 months after graduation.
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Remember, YOU are responsible for finding qualifying employment. We encourage you to look for job
postings and check your resources regularly.
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Contact the Title IV-E office and ask to get put on our weekly job listing email. We continue to assist you with
your job search by sending weekly emails, listing qualifying employment, consisting of Merit and non-Merit
jobs.
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CalSWEC’s central office will send information about counties that are hiring, and we will forward this to you
via email.
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CalSWEC also has an employment section on their Facebook page at
http://www.facebook.com/groups/100617546663064 or follow on Twitter at
https://twitter.com/CalSWECGradJobs.
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Merit System Services (MSS) https://secure1.cpshr.us/mss_jobs/JobListings.aspx
MSS will provide information for their 30 affiliated counties about which counties are hiring and any
other important information.
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Check for listings on county websites that are not affiliated with MSS.
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Chico State Career Center http://www.csuchico.edu/careers/
Contact Ken Naas for help with resumes and interview tips
KNaas1@csuchico.edu or 898-5253
• You report to us monthly regarding your job search status by updating and
emailing a Graduate Employment Search Form
• Email the completed and updated form on the first business day of each
month
• You must keep and submit all documents pertaining to your job search
• Confirming emails
• Appointment cards
• County letters or any other documentation
• We report to CalSWEC regarding your job search
• CalSWEC requires us to rate your job search according to your proven effort
(“Substantial Efforts”, “Adequate Search”, or “Needs Improvement”)
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County or Agency: Enter name of county or agency you applied to
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Merit System County? Y/N?: Answer Y or N if it is or isn’t a MSS county
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Classification: Enter position or job title applied for
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Application Date: Enter due date for application and date application was submitted
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Agency Contact Info: Enter name of contact person at agency, their phone number, and email address
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Response from County: If response received, summarize the correspondence from the county, including correspondence
through email, response card, letter in mail, notification of testing date, location, and time. If no response received, you will
follow up and report the outcome of that follow up in the Comments/Explanation box. (These are the types of documentation
that you will need to submit when you submit your monthly Graduate Employment Search Form.)
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Test Score: Enter test score, if available
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Place on list: If name was placed on list, enter placement number
 Notice from county: Enter how the county notified you regarding interview date, include the time and
location
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First interview date: Enter date of interview
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Second interview date: Enter date of second interview
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Job offer? Y/N: Enter Y or N
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Hire date: If hired, enter hire date
 Comments/Explanation: Add any relevant comments/explanation here
 Plan for Follow Up: Explain your plan is to follow up with this application
What if …
• I have a delay in completing the employment obligation? (medical
leave, maternity leave, etc.)
• I need an extension of time to complete the employment search?
• I want to change jobs prior to completion of the employment
payback?
• I want to permission to seek employment with a non-profit agency?
• While CalSWEC and the CSU, Chico Title IV-E Program anticipate
that you will be able to complete your program successfully and
begin your career in child welfare services, challenges may arise due
to personal circumstances or changes in the job market. The Petition
and Appeal processes are designed to resolve these challenges.
Read the Title IV-E Student Contract carefully. It provides the basic
obligations the University program has to you and you have to the
program. Because it is an agreement you sign, the Contract is the
controlling document in any disagreement arising between you and
the program.
• If you choose to petition, please contact Melissa Cheatham at
mcheatham@csuchico.edu for complete instructions and petition
documents.
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For special circumstances that
deviate from your contract and
delay and/or hinder you from
completing your employment
payback, you will follow the
Petition and Appeals Processes.
Request this form via email from
the IV-E office.
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You will be given a due date to
return the form.
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Your Project Coordinator will
review and come to a conclusion
regarding your request
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If you are not satisfied with the
decision made by the Project
Coordinator, you can use the
CalSWEC Appeals Process and
Form
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CalSWEC’s decision on the Appeal
is final
Please contact Melissa if you need to initiate the petition process.
• You need an extension of time to complete employment search
• There is any delay in completing your employment obligation
• switching from full-time to part-time employment
• medical leave
• maternity leave
• You want a waiver of agency, CDSS, or tribal employment requirement and
permission to seek a non-profit job
• You want permission to accept a particular non-profit job
• You want permission to change job prior to completion of employment
period requirement
• You want permission to modify or be relieved of
any contractual obligation
If you need/want to change employment (from one county to
another county) before your payback is complete, follow these
steps:
1. Request a CalSWEC Petition Form from the IV-E office
2. Complete and return the Petition Form
3. Complete a new Employment Verification Form, signed by
the county you are leaving, and mail to the IV-E office
4. Complete a new Employment Verification Form to your new
employer and mail to the IV-E office
• Vacation Time and Sick Time off are accrued through
employment and can be used toward completing your
employment payback.
• Unpaid Medical Leave or Maternity Leave or any other
unpaid interruptions in your employment will not be counted
toward your employment payback. We will recalculate your
completion date accordingly.
• You also need to submit a Petition Form.
• Keep us updated and stay in good communication with us!
• Should you have to go into monetary payback in lieu of
employment payback, for whatever reason, contact the IV-E
office ASAP
• See the Monetary Payback Agreement
• Reasons you might enter monetary payback:
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No longer working
No longer working in a qualifying position
Voluntarily leaving a position
Declining a job offer
Other circumstances that don’t comply with your contract
• Most forms can be located here at our Title IV-E Forms and Links
site:
http://www.csuchico.edu/swrk/ive/formslinks.shtml
• Forms you will find on the site:
• Graduate Employment Search Form
• Employment Verification Form
• Contact Melissa for petition/appeal forms
• Keep us updated about
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Changes in your employment status
Address change
Phone number change
Email change, etc.
• Email, call, or stop by anytime!
• If you’re having problems or have concerns regarding your employment that
could affect your payback obligation, get in touch with the IV-E office ASAP
• If at any time you are unsure of what form(s) you need or what the steps are,
contact the IV-E office and we will walk you through the steps and make sure
you have the right forms.
• We are here to help and support you through the end of your payback
obligation! 
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Melissa Cheatham –
• Job Search, Employment Verification & Tracking
• Monetary Repayment
• Petitions and Appeals
mcheatham@csuchico.edu
(530) 898-4261
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Meka Klungtvet-Morano –
• Petitions and Appeals
• General concerns, issues, etc.
mklungtvet-morano@csuchico.edu
(530) 898-6874
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Chelsea Cornell –
• Petitions and Appeals
• General concerns, issues, etc.
ccornell1@csuchico.edu
(530) 898-6754
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