Employer Data Form.xlsx

XLSX spreadsheet 18 KB Posted Jun 28, 2019

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Employer Data Form

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EDF

Employer Data Form

National Dislocated Worker Grant Application

U.S. Department of Labor / Employment and Training Administration

	Employer Information			Layoff Notification		Layoff Data				Rapid Response				TAA Petition		Union Information
#	Name of Company and Address of Facility Where the Layoff Occurred	Type of Business	Two-Digit NAIC Code	Notification Type (i.e. WARN)	Date of Notification	ClosureY/N	Layoff Date(s)	Number of Affected Workers	Number of Planned Participants	Contact with Employer Date	Contact with Workers Date	Number of Affected Workers Contacted	Number of Field Surveys Completed	TAA Petition Y/N	Date Filed	List Any Labor Organization Representation
1	XYZ Company, 300 Somewhere Ave, Boston, MA 00000	Mfg.	77	WARN	12/12/18	y	12/12/18	2,000	500	12/12/18	12/12/18	700	600	no	3/12/19	AFL/CIO
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