1272-Workforce of Central FlalA 7 2-
?f
- _' A
referred to as the
WORKFORCE Go\,C pnir�
CENTRAL FLORIDA kvqs
SUMMER YOUTH EMPLOYMENT PROGRAM c,p� ,
WORKSITE AGREEMENT
T , FLWDA (WCF) as the Regional Workforce Development Board, and
r , f whose address is a ° /Vo o
t" _ r7ry rte L 327 7 Z hereinafter
cy, agree to the following terms of this Agreement.
1, Program Overview
The Summer Youth Employment Program shall consist
of paid work experience, wherein a participant referred
by WCF to the Agency is introduced to age appropriate
activities with the rigors, demands, rewards, and
sanctions associated with holding a job reinforced
during the program. Under the guidance and
supervision of the Agency and in accordance with the
job description attached hereto, the participant should
be provided meaningful work experience that will help
them to receive the training and experience that is
required to be successful in the job. It is understood by
WCF and the Agency that no legal employer - employee
relationship is created or exists between the Agency and
the participant.
2. Period of Agreement n.�
This work site agreement, # SYEP 09 - fix shall
begin on June 22. 2009 and end no later than
t) '11-3 c . No participant shall begin work until
this AgN ement is fully executed by both the Agency and
WCF.
3 Work Experience Period and UmIltations
Participants may work up to 35 h urs /week.
Participant(s) may work for no longer than le weeks or
until this Agreement's end date, whichever occurs first.
4. Responsibilities of Agency
The following are responsibilities of the Agency. The
Agency accepts and agrees that it shall:
A. make available suitable job(s) at its worksite(s)
and in the respective occupation(s) described
in the job description(s) attached and hereby
made a part of this agreement, for those
eligible WCF participants who are selected and
referred to the Agency by WCF.
B. notify WCF immediately if any participant
referred by WCF would be directly supervised by
a member of that person's immediate family.
C. assign worthwhile and meaningful work to
participants during the entire time they are at
the work site in accordance with the approved
job description(s). Duties other than those in
the attached approved job description (s) must
be predetermined and mutually agreed upon by
the Agency and WCF.
D. direct and supervise participants' work
activities and training in accordance with their
job description(s).
E. assure that it will have supervisory personnel
who will act as work site supervisors for each of
the Agency's work sites so as to provide for
continuous on -site supervision and training of
participants at a ratio of participant(s) to staff
of no more than 5:1
F. orient and train their work site Supervisory
personnel including any alternate staff directly
responsible for the supervision of participants
as to the Agency's responsibilities and
obligations under this Agreement.
G. notify WCF immediately of any temporary
and /or ongoing changes in the designation of
personnel who will be supervising the
participant(s).
H. be accountable for maintaining WCF participant
time sheets, supervising the proper completion
of time sheets by each participant, approving
participant time sheets if all the prior
requirements are met, and submitting these
"timesheets" in a timely manner in accordance
with WCF payroll procedures.
1. require participants' conformance with the
benefits such as rest breaks, lunch, etc.
Agency's Personnel Rules of Conduct such as
as other current employees;
dress code, parking, etc.
R. ensure that the participants will not be employed
J. ensure that all sites where participants will be
at a casino or other gambling establishment,
assigned are sanitary and safe environments in
aquarium, zoo, golf course, or swimming pool.
accordance with health and safety standards
S. ensure that participants will not be employed in
established by State and Federal law.
the building, operating, or maintaining of any
K. ensure that all required safety supplies and
part of any building which is used for sectarian
equipment are used in the proper manner for
instruction or as a place of worship.
the intended use and in accordance with all
T. ensure that this agreement will not impair
laws, including child labor laws where
existing contracts for services or a collective
applicable.
bargaining agreement between the Agency and
L. conform to normal routines and functions
other parties, nor will this agreement assist,
befitting a reasonable business establishment,
promote or deter union organization.
including, but not limited to, appropriate
U. ensure that a work experience participant under
supervision on the premises at all times,
this agreement will not assist with political or
displaying positive work habits, maintaining
lobbying activities or any activity designed to
safe working conditions, and appropriate attire.
influence legislation or appropriation pending
M. inform WCF immediately should an accident or
before the Congress of the United States.
injury occur at the job site affecting or involving
V. not subcontract, assign or transfer any rights or
a participant and require the participant to
responsibilities under this agreement or any
complete a first report of injury form.
portion thereof without the prior written
N. notify WCF by telephone of any problem or
approval of WCF.
concern regarding a participant's performance
W. implement administrative controls to ensure
at a work site as soon as possible, but at least
that costs for wages and other costs that the
within 24 clock hours of when the problem is
WCF is responsible for paying are not being
identified.
paid by other federal, state, or local programs
0. not discriminate against any participant or
to eliminate the possibility of a duplication of
potential participant because of race, color,
funding.
religion, sex, national origin, age, disability,
X. maintain all records and files pertaining to the
political affiliation or belief, creed or marital
operation of this Agreement and any
status.
amendment hereto for three (3) years following
P. ensure that participants receive fair and
expiration of this Agreement. Records and files
impartial treatment and that participants shall
shall include, but not be limited to, time and
not be subjected to harassment of any type or
attendance sheets, supervisor assignments,
form.
this Agreement, etc.
Q. ensure that the following general working
Y. monitor to ensure that all participants at all
conditions are complied with:
work sites are only performing work activities
1) this work experience position(s) shall
as identified in the job description attached
result in an increase in the Agency's
hereto and that the Agency is complying with
level of employment and in no
this Agreement. The Agency shall notify WCF of
circumstances shall it result in the
any changes to the required work hours, job
displacement of current employees or
description, and /or if the work has been
the freezing of the hiring of new
completed and the job needs to end.
employees in anticipation of this work
Z. immediately advise WCF in writing of any
experience participant;
actions, suits, claims or grievances filed against
2) there shall be no displacement or
the Agency, WCF, State of Florida, federal
partial displacement (reduction of hours
officials or participants that in any way relates
worked, wages or employment benefits)
to this Agreement.
of currently employed workers nor
AA. allow WCF, the Governor of the State of
replacement of laid -off workers by the
Florida, or any of its agents and /or
work experience participant(s);
subcontractors, and the US Department of
3) there shall be no infringement of
Labor (DOL) access to the Agency's work site(s)
promotional opportunities for regular
at all reasonable hours for such purposes as
employees; and
monitoring the program, counseling the
4) participants shall receive comparable
participants, etc.
working conditions and non - payroll
BB. adhere to all employment and applicable child
labor laws. See
htto: / /WWW.yQuthrules.dol.goy /about.htm and
htto: / /www.osha.goy.teens for details on child
labor laws.
CC. maintain the confidentiality of any information
regarding participants or their immediate
families which may be obtained from forms,
discussions or other sources. Without
permission of the participant, such information
shall be divulged only as necessary for
purposes related to the performance of this
Agreement.
DD. consider all work experience participants for
any unsubsidized job openings which may
occur with the Agency, if participants meet the
necessary qualifications for the openings.
5. Responsibilities of WCF
WCF, and its designee /subcontractor, accepts and
agrees that it shall
A. recruit, select and refer participant(s) eligible
for this work experience program to the Agency.
B. assist the job site supervisor in resolving any
problems concerning the participants'
performance on the job.
C. hear all grievances concerning program
participant's performance at the job site in
accordance with WCF's participant grievance
procedures.
D. provide counseling and supportive services to
participants as the need is identified and
budget allows.
E. be responsible for distributing participant
paychecks dependent on Agency's timely
submission of properly completed and signed
timesheets.
F. WCF or its designee shall be responsible for
employing the participants, paying participants
for all actual hours worked, and providing
Workers' Compensation coverage for all
participants. Note, no fringe benefits or holiday
pay is provided to these temporary workers.
G. monitor the activities under this Agreement at
the work site(s) at reasonable hours and as
frequently as the authorized representatives of
WCF may deem necessary in order to assure
the work experience is constructive for the
participant and that all provisions of this
Agreement are being carried out. Require
corrective action within specified time periods
or remove participants from work sites without
prior notice other than a written notification to
be delivered to the Agency at the time of the
removal. This action may be taken when WCF,
the Governor of the State of Florida, or DOL
finds serious or continual violations of rules or
laws, where violations are not being remedied,
or where WCF, the Governor of the State of
Florida or DOL find noncompliance on any of
the terms or conditions under this Agreement.
H. furnish the Agency with copies of all procedures,
forms, etc. which it deems necessary for the
proper conduct by the Agency.
6. Hold Harmless
Without waiving its sovereign immunity, and if and to
the extent allowed by law, each party shall indemnify
and hold harmless each other, its officers, officials, and
employees from and against all claims and liabilities of
any nature or kind, including costs and expenses for or
on account of any claims, damages, losses, or expenses
of any character whatsoever resulting in whole or in part
from the negligent performance or omission of either
party's employees or representatives connected with
the activities described herein.
In agreeing to provide direction, training and supervision
of the participant, the Agency understands that this
does not make WCF or its designee liable to the Agency
or any third party by reason of any future act or failure to
act by any participant on or off the job.
7. Changes to the A¢reemerrt
This agreement may be modified or amended as
necessary by the issuance of a written modification,
signed and dated by both parties.
8. Termination
This Agreement may be terminated as follows:
A. WCF or the Agency may terminate the
Agreement for convenience upon thirty- (30)
calendar day prior written notice to the other
pa rty.
B. WCF may terminate this Agreement in whole or
in part at any time that the WCF C00, in his /her
sole judgment, determines that:
1) the Agency has failed to comply with any
of the provisions contained in this
Agreement or any modification hereto;
2) the Agency fails to perform in whole or
in part under this Agreement or fails to
take corrective action after receiving
oral or written requests to do so within
an appropriate time period as may be
stipulated by WCF; or
3) the United States Department of Labor
or State of Florida fails to provide
adequate funds, reduces, eliminates or
otherwise terminates the program
under which this Agreement is written.
. Notice
Other than as provided herein, notice shall be required
to be given to WCF under this Agreement, and shall be
sufficient when hand delivered or mailed to WCF at its
office at 707 Mendham Boulevard, Ste. 250, Orlando FL
32825, attn: C00. All notices required to be given to the
Agency under this Agreement shall be sufficient when
hand delivered or mailed to the Agency at its office
located at the address identified in paragraph one, page
one of this Agreement.
10. Controlling Laws
This agreement and the provisions contained herein
shall be construed, controlled and interpreted according
to the laws of the State of Florida.
IN WITNESS THEREOF, the parties hereto having been duly authorized and representing that they have the power and
authority to execute this Agreement and perform the responsibilities specified herein have made and executed this
Agreement on the respective dates under each signature.
AGENCY:
�o
Fed W l ID #
e� Ile( 6/
Signature
P, Ye L
Typed Name
Typed Title
n( / t (f / a00�
Date
WORKFORCE CEN LO A (WC
A ' e J. Cob , Executive Vice President /C00
49
az
Date
CFDA #
Email address
�o
Fed W l ID #
e� Ile( 6/
Contact Name
Phone number
Fax numb
//7j %(u/'S' /cE Cie;
WORKFORCE CEN LO A (WC
A ' e J. Cob , Executive Vice President /C00
49
az
Date
CFDA #
Email address
WORKFORCE
CENTRAL FLORIDA
AUTHORIZATION AND RELEASE FOR MEDIA
I hereby authorize the use, of the name of company /organization IJZ d/7��L ✓� and all
individuals representing this company /organization, the likeness, quotes, itory, and all materials or performances, which
are hereby provided for use in print materials such as annual reports, newsletters, press releases and brochures.
This authorization bestows upon WORKFORCE CENTRAL FLORIDA, and their respective licensees, successors, and
assigns (hereinafter called the "licensed parties ") the right to record in whole or in part on camera, quotes, story,
videotape, film, or audio tape, the materials or performance described, the name, the likeness, and voice, and to use such
recorded program(s) for industrial /educational programming, as well as for all audiovisual instructional, advertising and
promotional purposes.
I agree that all recorded or filmed likenesses of the company /organization and /or its employees used and taken by the
licensed parties are owned by them and that they may copyright material containing same. If I should receive any print,
negative or other copy thereof, I shall not authorize its use by anyone else.
I agree that no program(s) sequence(s) or other material need be submitted to the company /organization and /or its
employees for any further approval and the licensed parties shall be without liability to the company /organization and /or its
employees for any distortion or alteration that may occur in the editing of said programming.
I hereby certify that: (1) 1 am legally "of age "; (2) 1 am free to enter into this agreement; (3) 1 may sign for the
company /organization; (4) 1 possess all rights necessary to furnish the materials and /or performance submitted herein
under free and clear of any liability or limitation on ownership; and (5) 1 agree to indemnify and hold harmless the licensed
parties against any action for copyright or patent infringement, invasion of the rights of others or any other related claim or
action which may arise from the licensed parties use of the materials or performance I have provided.
I hereby authorize the licensed parties to use in perpetuity, and at their discretion, the recorded and /or filmed, etc.
material(s) descr' d above in the manner st d.
COMPANY: , i
SIGNED
ADDRESS: 30 0 �'4` , [c f/re
r
PHONE: - 7
DATE: • 1(c .0
WITNESS: r
Silmmer Youth Program Worksite Application
Response Details
System
ID
1687285
ay, 2009 07:48:38 AM
Timestamp
PDT
IP Address
68.208.86.34
Time Taken
842 seconds
Weight
0.0
Source Identifier
Email
Address
Email List
Questions marked with a * are required
Organization
City of Sanford
Address
300 N Park Ave
City
Sanford
State
FI
Zip
32772
Website Address
www.ci.sanfordfl.gov
Contact Person
Joyce McCoy
Title
Sr. HR Analyst
Phone
407 688.5134
Cell
Fax
407 688.5131
Email
rigginsj @sanfordfl.gov
Preferred Method of Contact'
Email
Integration Tags
Custom Tags
custom0
custom 1
custom2
custom3
custom4
customs
Geo Coding
Country US
Region FL
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Page 1 of 11
51
5/18/2009
Summer Youth Program Worksite Application
Type of Organization
)) Government
Give a detailed description of the organization's year -round function.
Local Government
Page 2 of 11
Identify the worksite address and describe the location where the WORKFORCE CENTRAL FLORIDA Summer Youth
participant would be located (if multiple locations, please include all).
Sanford City Hall and Outside Divisions
Are you required by law to conduct any other type of background check or employment screening for individuals you hire
into temporary jobs such as this one?
Yes
What type of equipment, tools and /or machinery, if any, will the participant(s) be using?
Various
Do you have sufficient equipment and /or supplies for the participant(s) to perform the assigned duties?
Yes
Is the proposed worksite location wheelchair accessible?
)) Yes
Will the participant(s) be operating a vehicle?
No
Will the participant(s) be involved in outdoor activities?
)) Yes
If yes, do you have an alternate plan for inclement weather?
» Yes
How many staff members will be responsible for supervising the youth participant(s)?
Job Title
Labor and Clerical
Number of Job Openings
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Summer Youth Program Worksite Application
Task #1
Maintenance
Task #2
Clerical
Task #3
Typing
Task #4
Copying
Task #5
Answering Phones
Task #6
Task #7
Task #8
Task #9
Task #10
Preferred Qualifications and /or Special Requirements.
Office Equipment
Page 3 of 11
Skills to be acquired through this summer job work experience position (specify job position title; i.e. Food Bank Stock
Clerk).
Maintenace/Clerica
Work Skills'
» Taking initiative to learn new things
))Working Independently
» Dressing Professionally
Personal Skills .
» Effective Communication
» Teamwork
))Time Management
Work Related Skills `
Use of work - related equipment
» Use of computerslinternet
» Office Procedures
» Customer service
Name of Direct Supervisor
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Summer Youth Program Worksite Application
N/A
Title
N/A
Phone
N/A
Cell
N/A
Email
N/A
Will the Direct Supervisor be on vacation between 6/22109 and 12/31/09 ?'
» No
If Yes - From (XXIXX /XXXX)
N /A
To (XX/XX/XXXX
N/A
Name of Supervisor Alternate
N /A
Title
N/A
Phone
N /A
Cell
N /A
Email
N/A
Will the Supervisor Alternate be on vacation between 6122/09 and 12/31109 ?'
No
If Yes - From (XX /XX/XXXX)
N/A
To (XX /XX/XXXX
N/A
Department
Various Dcpartmcnts
Address
300 N Park Ave
City
Sanford
State
FI
Zip
32772
Page 4 of 11
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Summer Youth Program Worksite Application Page 5 of 11
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid for their lunch time.
Monday TuesdayWednesday Thursday Friday Saturday Sunday
Start Time 8:00 8:00 8:00 8:00 8:00 n/a n/a
End Time - 4:00 4:00 4:00 4:00 4:00 n/a n/a
Total Hours Per Week?
35
Name of Person Completing This Online Form
Joycc McCoy
Title
Sr. HR Analyst
Phone
407 688.5134
Cell
n/a
Email
rigginsj @sanfiordfl,gov
Enter Your Full Name to Digitally Sign This Form
Joycc R McCoy
Date
05/18/2009
Do you have Multiple Work Experience positions available? If you answer "Yes" you'll be asked to complete the "Additional
Job Description" section of this application for each additional individual Job Title you plan to fill. Please complete a
separate Job Description section for each additional Job Title. "
No
Work Maturity Skills `
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Sttmmer Youth Program Worksite Application Page 6 of 11
Personal Skills *
Work Related Skills *
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT.paid for_their_ lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time *
End Time *
Work _Maturity Skills *
Personal Skills *
Work Related Skills *
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Summer Youth Program Worksite Application
Page 7 of I I
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid_ for.their_ lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
End Time
Work Maturity Skills `
Personal Skills "
Work Related Skills "
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid for their lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time x
End Time ;
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Summer Youth Program Worksite Application
Work Maturity_ Skills'
Personal Skills "
Work Related Skills `
Page 8 of 11
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT for their lunch_ time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
End Time
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Summer Youth Program Worksite Application
Work Maturity Skills_ *
Personal Skills *
Work Related Skills *
Page 9 of 11
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are N0T paid for their lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time *
End Time
Work_ Maturity_ Skills *
Personal Skills *
Work Related Skills *
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Summer Youth Program Worksite Application
It
Page 10 of 11
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid for their lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
End Time
Work -Maturity _Skills '
Personal Skills "
Work Related Skills'
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid for their lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
End Time
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Stammer Youth Program Worksite Application
Work _Maturity Skills'
Personal Skills "
Work Related Skills `
Page 11 of I I
Participants may work no more than 35 hours per week. Indicate below, the time and days you want the participant(s) on
the job. Youth are NOT paid for their lunch time.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
End Time
Please contact syep nj_wc fla corn if you have any questions regarding this online application.
Poicered By QuestionPro_Survey Sofhvare
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