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It requires the employer to input trainee details, specific training and retention dates, gross wages paid, and relevant payment amounts based on program guidelines. The form includes a certification section where the employer confirms the trainee's employment status, work hours, and wage payments. Additionally, it provides space for the Erie County Department of Job and Family Services (ECDJFS) representative to verify documentation through payroll records or time sheets, ensuring compliance with program requirements for partial wage reimbursement up to set limits. 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List any gaps in employment during the retention period:   (days) . If the gap exceeds fourteen (14) days, the retention period has been extended for an equal number of days.  \nEmployer Signature:   Date:    \nName:   Title:    \nGross wages have been verified by ECDJFS by viewing (check the appropriate box):  \n Time sheets  Payroll records  Paycheck stub  Other (list):    \nECDJFS Representatives  \nECDJFS Signature:   Date:    \nName:   Title:","cbCaiacNbh6oyFbv","https://ap.wps.com/l/cbCaiacNbh6oyFbv","pdf",123468,"English","# Training and Retention Payment Details\n## Certification of Employment\n## Verification of Wages","[{\"question\":\"What is the maximum amount that can be requested for training or retention?\",\"answer\":\"Payment is requested for one half of the gross wage amount shown, or $4000.00, whichever is less.\"},{\"question\":\"What is the required weekly working hour commitment for the trainee?\",\"answer\":\"The trainee is expected to work at least thirty-two (32) hours each week.\"},{\"question\":\"How does the employer provide proof of gross wages to the ECDJFS?\",\"answer\":\"The employer must check the appropriate box to indicate verification via time sheets, payroll records, paycheck stubs, or other listed documentation.\"}]","On-the-Job Training Invoice - Reimbursement Request Form | PDF",1790016131]