Montgomery County Georgia Web Portal

Department of Veterans Service
State Approving Agency
Floyd Veterans Memorial Building, Suite E-970
Atlanta, Georgia 30334
 

TRAINING REQUEST ON-THE-JOB TRAINING (OJT) – APPRENTICESHIP (APP)
FAX (404) 657-6276                Telephone (404) 656-2322/2306

(COMPLETE PARTS (1) & (2) AND FORWARD TO THE ADDRESS LISTED ABOVE)

USE THIS FORM TO - SEEK APPROVAL FOR A VETERAN’S OJT/APP PROGRAM,
OR TO ADD A TRAINEE TO AN EXISTING APPROVED PROGRAM.

 SECTION 1 - EMPLOYER COMPLETE:   (PLEASE PRINT CLEARLY)

 NAME OF ESTABLISHMENT:____________________________ PHONE NUMBER: (____) ___________
     

ADDRESS:  _________________________________________  FAX NUMBER:  (_ __)______________
     

CITY/STATE/ZIP CODE: _______________________________________________________________

EMAIL:  ___________________________________________________________________________
     

ENTRY LEVEL JOB OR SKILL FOR WHICH TRAINING REQUESTED: ________________________________________________________________________________
     

PERSON TO CONTACT:   ____________________________________________________________   

TITLE:  __________________________________________________________________________
     

Date trainee began training at this location for this job: (mm/dd/yy) ________________.  Salary as of this start date:  $______________
     

Previous experience or education toward this skill, prior to the starting date indicated above, must be evaluated and prior credit  granted if it is appropriate.
     

I certify that prior training/experience has been evaluated and that the trainee has been granted ___________months of credit toward the total months required for this job. 

(If no credit is granted, state “none” ) .                        

___________________________________/ __________ /_________________________
      Certifying Official’s / Employer’s Signature        Title                    Date (mm/dd/yy)

 SECTION 2 - TRAINEE COMPLETE:   (PLEASE PRINT CLEARLY)

      NAME:  ________________________________________________________________________________________________
                           First                    Middle                Last
     

MAILING ADDRESS:___________________________________________________________________

PHONE:  (_______)__________________________
    

CITY/STATE/ZIP        ______________________________________________________________________________________
    

SSN/VA CLAIM NUMBER: -______________________________ DATE OF BIRTH: (mm/dd/yy)______________    

VA CLAIM NUMBER (CHAPTER 35 ONLY): ___________________________________       
    

Active Service Dates: Entered (mm/dd/yy): ________________

Separated from active duty: (mm/dd/yy) ________________
         

Did you contribute toward Veterans Educational (GI Bill/VA) benefits?   Yes____     No____
         

If you contributed, did you later withdraw your contribution?    Yes____     No____
         

Are you a member of the Armed Forces Reserve or National Guard attending drills monthly for pay?            Yes ____    No____
         

If yes, date current contract started (mm/dd/yy): ___________________

Contract completion date :____________________
        

Have you been activated as a Reservist at least 90 consecutive days or more since September 11, 2001?          Yes ____  No ____
        

Have you had schooling or training under the GI Bill before?                                                                Yes____    No____
        

If yes, please provide the following for period of last use: 

Institution’s name:_______________________________________
Institution’s location (city/state): ________________/____________
Last date of attendance/training (mm/dd/yy) : _____________________
Nature of training or program of study ________________________

How did you find out about this program? ___________________________________________________________________
 SECTION  3 -  DEPARTMENT OF VETERANS SERVICE USE ONLY
     
      The following forms are required for this enrollment:
      (   ) VSO Form 61     (   ) VSO Form 62     (   ) VSO Form 63     (   ) VSO Form 64     (   ) VSO Form 90     (   ) VA Form 21-22
      (   ) VA Form 21-686c     (   ) VA Form 22-1990/5490     (   ) VA Form 22-1995/5495     (   ) VA Form 22-1999

      Chapter of Eligibility __________   
      Credit granted __________months.       
      Hours of work/training each week: ______________hours
      Enrollment period:  From (mm/dd/yy) ________________To (mm/dd/yy):_________________
   
  VSO Form 55 (Revised 1-11-06) Previous editions may not be used.