CARES Employer Grant Application

Attachment 1
CARES Employer Layoff Aversion Grant Application
Section 1: Business Information
Date of Application: *

Month Day Year
Date
Business Name: *
Business Website: *
Business Mailing/Street Address: *
City: *
State: *
Zip: *
County: *
Brief description of your business services or products: *
Date of Inception or Founding: *

Month Day Year
Date
Number of Years in Business: *
Number of full time employees at this location: *
Primary Business Contact Name: *
Title: *
Phone: *
Email: *
example@example.com
Finance Contact Name: (person to submit grant reimbursement invoice) *
Phone Number: *
Email: *
example@example.com
*What is your Data Universal Number System (DUNS) #? *
Employer Federal ID #: *
Tennessee Sales Tax ID #:
*In order to complete and issue a contract, the Employer must have a DUNS number. The DUNS number is a nine digit identification number that uniquely identifies business entities. One can be obtained free of charge at http://www.dunandbradstreet.com or by calling 1-866-705-5711.
Section 2: Layoff Aversion Grant Request Narrative
Briefly describe how COVID-19 has impacted your business. *
Briefly describe your Layoff Aversion Project, dates applicable are from April 1, 2020 – November 15, 2020. Examples: Provide employee training, Purchase laptops, printers or electronic devices to allow employees to work remotely, Purchase additional cleaning and sanitizing equipment or PPE to reduce the risk of exposure, Implement new business strategies or new business delivery model, etc *
Section 3: Layoff Aversion Grant Request Budget Request

Budget Request *

Item Description

Cost

# Employees

Served

*Date of Purchase

Total amount requested: *
*If request if being made for items already purchased after 4/1/2020, please include the date and amount. A copy of the invoice/receipt and payment will be required for reimbursement.
Section 4: Layoff Aversion Grant Authorized Signatures
As an authorized representative of the business listed on this application, I hereby certify that the information provided on this application is true and accurate. I am aware that any false information or intended omissions may subject me to civil or criminal penalties for filing false public records and/or forfeiture of grant funds.
Business Name *
Printed Name of Signatory *
Signature *

Clear
Title *
Date *

Month Day Year
Date
Section 5: Grant Award Reimbursement Process
Businesses awarded the Layoff Aversion Grant enter into a contract with Workforce Essentials which commits the business to complete the training and/or project as proposed in the application prior to November 15, 2020.

Approved budget items are reimbursed upon presentation of adequate documentation of the expense.

1. Reimbursement requires documentation of payment made. Proof of payment may be documented in one of the following formats: i.C ancelled check ii.Credit Cardstatement iii.ACH printout 2. Reimbursement requires the submission of a W-9 form. 3.Employers must submit reimbursement requests with required support invoices attached no later than

4.Employers will keep accurate records of the project’s implementation and certify that all information provided for the purpose of requesting reimbursements and reporting training activity is accurate and true.
Please upload your W-9 here. *

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Section 6: Internal Administrative Use Only
Date Application Received

Month Day Year
Date
Amount Awarded
Date Application Reviewed

Month Day Year
Date
Date Reimbursement Requested

Month Day Year
Date
Date Contract Signed

Month Day Year
Date
Date Reimbursement Processed

Month Day Year
Date
Should be Empty:

CARES Employer Layoff Aversion Grant Application

Section 1: Business Information

Section 2: Layoff Aversion Grant Request Narrative

Section 3: Layoff Aversion Grant Request Budget Request

*If request if being made for items already purchased after 4/1/2020, please include the date and amount. A copy of the invoice/receipt and payment will be required for reimbursement.

Section 4: Layoff Aversion Grant Authorized Signatures

Section 5: Grant Award Reimbursement Process

Section 6: Internal Administrative Use Only