Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].
I understand and agree that I am responsible for the well-being of me and my family. Wisconsin Works (W-2) may help me find and keep a job to meet my responsibilities. If I am eligible for W-2, I agree to the following:
- My goal is to find and keep a job that is within my capabilities. If I am placed in any W-2 employment position, I will still look for and accept a job. I may not be eligible for W-2 if I refuse to take a job, quit a job, or get fired from a job without a good reason.
- I will meet with a Financial and Employment Planner (FEP) and take part in an assessment. My answers will be kept confidential and used to help me in the W-2 program. I understand that if I tell my worker about any children being abused, my worker must report the information to child protective services.
- I understand that if I have a job or if I am ready for a job, I may be assigned to a case management position (CMU or CMJ) and receive assistance in finding a job, keeping a job, or finding a better paying job, but I will not receive a cash payment. If I am not ready for a job, my FEP may put me into one of the following paid W-2 employment positions depending upon my employment history and my job readiness:
- Trial Employment Match Program (TEMP): A job with an employer who may hire me permanently. If placed, my employer will pay me at least minimum wage for the hours I work.
- Community Service Job (CSJ): A work and training placement that helps the community while helping me prepare for a job. I will receive a monthly payment in return for up to 40 hours per week of participation in W-2 activities. In most cases education and training is limited to 10 hours per week.
- W-2 Transition (W-2T): If I am unable to participate in a CSJ position, I may be placed in W-2T. I will receive a monthly payment in return for up to 40 hours per week of participation in W-2 activities. In most cases education and training is limited to 12 hours per week.
- I understand that I must participate in all activities assigned on my Employability Plan (EP).
- I must tell my FEP immediately if I cannot do the activities assigned on my EP because I do not have child care, cannot work because of a medical reason, have to go to court or for any other reason. If I have a medical condition that affects my ability to work, I may be asked to participate in a medical exam or other type of assessment to determine if special services or accommodations are needed. If I refuse to cooperate with this exam/assessment, I may be assigned to activities without consideration for the medical condition.
- Complete attendance forms for all of the hours in which I attend W-2 activities.
- If I fail to do any of the activities assigned on my EP without a good reason, any one of the following may happen:
- If I am in a CSJ or W-2T employment position, my payment will go down by $5.00 for each hour I fail to do what I was assigned on my EP without a good reason.
- I may be denied future W-2 eligibility for up to 180 days from my last application date.
- I understand that W-2 work assignments will:
- meet all federal and state labor laws and rules that apply;
- meet all federal, state, and local health and safety standards and be free of discrimination;
- not require me to give up any labor or union rights; and
- not replace a worker who is on strike, lockout, or involved in another bona fide labor dispute.
- I understand that I or other members of my household also assigned activities must follow the rules of the W-2 program to find a job or keep a job. If I or other members of my household assigned activities do not follow the rules of the W-2 program, I can be denied W-2 eligibility for 90 days for refusal to participate. I understand that a refusal to participate means that I or another member of my household assigned activities:
- Was fired from employment for misconduct or engaged in misconduct at the W-2 agency or at a place providing work, work experience, training, or W-2 services.
- Failed to show up or showed up more than 15 minutes late for an interview with a potential employer, a job fair, or a meeting with a potential employer.
- Left an interview or a meeting with a potential employer before it was over.
- Showed up for an interview or a meeting with a potential employer dressed inappropriately or appearing unpresentable after receiving directions or training.
- Failed to complete a job application required by a potential employer.
- Communicated to a potential employer unreasonable work requirements that resulted in ineligibility for employment.
- Provided incorrect or incomplete information about qualifications in an interview or job application that resulted in ineligibility for the job after receiving directions or training.
- Quit appropriate employment or refused a genuine offer of appropriate employment.
- Failed to participate in assigned activities resulting in a 20% or more reduction in W-2 benefits for two months in a row or for three months in a six-month period.
- Refused or failed to follow a verbal or written direction from W-2 agency staff or staff at a place providing work, work experience, training site, or W-2 services.
- Used vulgar or profane language or engaged in abusive behavior directed at staff or others in the W-2 agency or a place providing work, work experience, training, or W-2 services.
- Violated written work rules developed by the W-2 agency or a place providing work, work experience, training, or W-2 services.
- I will help to legally name and/or locate the other parent(s) of my child(ren). If I fail to cooperate with the local child support agency three (3) times, I will not be eligible for W-2 or child care until I do cooperate or for six (6) months, whichever is longer.
- I will give proof of information needed within seven (7) working days of being asked. I will report changes in income, assets, and family structure within 10 days. I will report my child(ren) moving out of my home within five (5) days. If I give false information on purpose, I may be prosecuted.
- I understand that I must tell my worker if I have been convicted of a drug felony for an offense that happened within the last five years. If I refuse to provide this information, I may be denied W-2 services. If I have been convicted of a drug felony and I am placed into a CSJ or W-2T position, I must submit to a drug screen test. If my drug screen is positive my benefits will be reduced. If I refuse to submit to a drug screen, I may be found ineligible for W-2 services.
- I understand that I must have appropriate care for my child during the hours I am participating in W-2. I can contact my local Child Care Resource and Referral agency to help me find child care. If I cannot find appropriate child care I will tell my FEP.
- I understand that CSJ and W-2T payments will not increase if I have more children.
- I will make sure my children go to school. If they do not go to school, my payments may be reduced.
- I will report a change in earned or unearned income or assets within ten (10) calendar days. I understand that if I do not report the change, I may owe money for W-2 payments I should not have received.
- If I receive a W-2 payment in error, I must pay it back.
- I understand that I must not give false information to the W-2 agency about myself or my household members.
- I understand that I can be denied W-2 or my W-2 payments can be terminated if I or one of my household members with my knowledge is found to have intentionally given false information so that I can become or stay eligible for W-2 services. I can be denied W-2 eligibility for 6 months for the 1st time, 12 months for the 2nd time and permanently for the 3rd time. I may also be prosecuted for fraud if I intentionally give false information to receive payments or services.
Disability Assistance Available
I understand that if I have a disability, I may be eligible to receive assistance otherwise known as reasonable accommodations from the W-2 agency to help me participate in assigned work and training activities.
What is a disability? The definition of disability under the Americans with Disabilities Act (ADA) is very specific and may not be the same as the definition used by other programs and services. Under the ADA, a person is protected against discrimination based on their disability if they have a condition that affects their ability to do physical activities (examples: walking, seeing, breathing, hearing, etc.) or have a mental condition (examples: learning disability, depression, history of addiction, anxiety, phobia, etc.) Not all limitations are considered a disability under the ADA. Individuals may be required to provide documentation or proof from a medical professional regarding the presence and severity of the disability.
What assistance is available? Accommodations may be available to allow an individual with a disability to participate in work or training activities. Each person may need a different type of assistance depending on his/her disability. A request for assistance will be reviewed on a case by case basis to determine if a disability exists that makes it difficult for an individual to participate in training and work activities and if so, what type of assistance s/he may need.
Examples of the type of assistance that may be available include:
- Providing or making changes to equipment or devices so that someone with a disability can operate them;
- Changing the work or training schedule so that someone with a disability can still participate;
- Making changes in the test or instructions that are needed for a job or training program so that someone with a disability can take the test or understand the instructions;
- Providing readers and sign language interpreters to help people with disabilities understand what is being said or understand the written information that they are asked to read; and
- Making changes to the buildings or spaces so that people with disabilities can get into them and use the facilities that are available to all other employees (examples: bathrooms, parking spaces, ramps, and electric doors, etc.).
If I feel that I am a person with a disability and will need assistance due to my disability while participating in the W-2 program, I will talk to my FEP about it.
W-2 Time Limit
- I understand that my participation in a TEMP, CSJ, or W-2T position is limited to 24 months.
- Over my lifetime, I can only be in paid W-2 employment positions for a total of 60 months (5 years). Each month I am placed in a paid W-2 employment position counts, even if I don’t receive a payment because I failed to do what was assigned on my Employability Plan without a good reason. Time limits do not apply to W-2 case management positions, Child Care Assistance, Medicaid, or FoodShare.
- The time limits may not count while my child is under 8 weeks old. If my child was born more than 10 months after I first received AFDC/W-2, the time limits will count unless the child was the result of sexual assault or incest and I reported it.
- I understand that my FEP will review with me at least every six months how much time I have used on both my 24-month and 60-month time limits.
- I understand that I could get an extension to the 24-month and 60-month time limits. This could happen if I meet certain conditions. The W-2 agency must review with me and decide if I meet those conditions when I get near my time limit. I can ask my FEP at any time how much time I have left and if I might be able to get an extension if I am near the end of my time limit.
I UNDERSTAND AND AGREE:
- I will not be eligible for a W-2 employment position if I do not sign this Participation Agreement.
- I may choose not to accept a paid W-2 employment position and save my limited months of W-2 eligibility for future need.
- To abide by all the provisions of this Participation Agreement. I may not be able to participate in the future if I do not cooperate with the W-2 agency.
DCF-F-DWSP10755 (R. 01/2019)