REV-UP! Employer Application

REV-UP! Employer Application
To submit your application complete as much as is known on the form below, with all asterisked questions re: Employer contact information and certification being required. Other fields can be updated with the REV-UP! representative at a later date but will need to be provided prior to contract execution for mentor wage subsidy reimbursement.
Employer Contact Information
First Name*
Last Name*
Job Title *
Company Phone *
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Cell Phone
Please enter a valid phone number.
Company Information
Company Name*
Street Address*
Town*
State*
5-Digit Zip Code*
Company Website *
Please include http:// or https://
NAICS Code*
Year Established *
Number of Full-Time CT Employees *
Is Your Company Women Owned?*

YesNo
Is Your Company Minority Owned?*

YesNo
Is Your Company Veteran Owned?*

YesNo
Company Status
Are you a registered apprentice employer with the CT DOL and OAT?*

YesNo
Are you a registered apprentice employer with the CT DOL/OAT?

YesNo
Identifying Talent
Are you looking for a pre-qualified candidate in your community or are you looking to upskill a current employee?*

I am looking for a pre-qualified candidate to fill a job openingI am looking to upskill a current employee in my company
Job Opening Information
Job Title *
Brief Job Description *
Required Skills and Experience*
Required Skills and/or Experience
Hourly Wage (range) *
Location of Job *
Please provide the town.
Hours per Week *
How many hours per week do you expect the employee to work?
Shift Position*

1st Shift2nd Shift3rd ShiftOther
Upskilling a Current Employee
How is your employee eligible for REV-UP?*

The employee was hired less than two months ago and was unemployed or not fully utilizing their skills and potential prior to hireThe employee was promoted with a wage increase less than two months ago and was not fully utilizing their skills and potential prior to their promotionThe employee is a part-time or temporary employee moving into a full-time positionThe employee is not fully utilizing their skills and potential and will receive a wage increase as a result of the program
Employee First Name *
Employee Last Name *
Current Job Title *
Employee Start Date*

MonthDayYear
Date
Current Wage *
Anticipated New Wage *
All incumbent workers must receive a wage increase as a result of this program unless they were recently hired or promoted two months prior to submitting the initial application.
Describe the proposed REV-UP! training(s) you'd like to use to upskill the employee in Industry 4.0 technologies or other training aligned with your company.*

Online CoursesLive CCAT TrainingCustomized Company Training
Describe the proposed REV-UP! training you'd like to use to upskill the employee in Industry 4.0 technologies or other training aligned with your company.
Certification & Signature
Certification*

By checking this box, I certify to the best of my knowledge that the company meets the eligibility requirements for using these resources, including that the company will provide the CT Letters of Good Standing, that the company will hire someone new or upskill a current employee. In both scenarios, the individual needs to be unemployed or underemployed and that all of the information provided herein is accurate as stated. Underemployed has been defined as an individual who: a) is not currently connected to a full-time job that pays at the same level of their education skills, or wage and/or salary earned previously, or b) have obtained only episodic, short-term, interim, per diem, temporary or part-time employment. I also understand that if awarded funding under REV-UP!, my organization will be responsible for partnering on training plans and results and providing further payroll information for wage subsidy processing.
Signature *
Please type your first and last name.
Public Announcement
Please be advised that your company and project may be highlighted in a press release and/or used for Economic Development Metrics issued by the state. In addition, your company will be required to submit reporting data regarding your program participation up to 12 months after your application. Company propriertary or trade secret information will not be disclosed.
By submitting this form, you acknowledge that the information provided will be collected by the Connecticut Center for Advanced Technology, Inc. (CCAT).

CCAT Privacy Policy
Next Steps
CCAT's REV-UP! team will review your application, and schedule meetings as soon as possible to review your application and discuss REV-UP! details and timelines.

If you have any questions, please contact Marianne Martinez at mmartinez@ccat.us or 860-282-4204 for North Central CT employers (Capital Workforce Partners geographic region) or Eileen Candels at ecandels@ccat.us or 860-558-5796 for all other areas outside of North Central CT.
CCAT received support for this project from the Office of Workforce Solutions CareerConneCT program.
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REV-UP! Employer Application

Employer Contact Information

Company Information

Company Status

Identifying Talent

Job Opening Information

Upskilling a Current Employee

Certification & Signature

Public Announcement

Next Steps