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WIA5 (Rev 8/12)ELIGIBILITY AND CERTIFICATION FOR DISLOCATED WORKERS Name: Date: SSN: Address: Phone: Eligibility Criteria (Check Appropriate Eligibility Category: A, B, C or D)A. All three boxes must
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Who needs wia-5 rev 812?

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The WIA-5 Rev 812 form may be needed by individuals or organizations involved in the following circumstances:
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- Individuals or job seekers who are applying for Workforce Investment Act (WIA) programs or services.
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- Training providers or educational institutions enrolling participants in WIA-funded programs.
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- Employers or business entities participating in WIA initiatives or hiring individuals through WIA programs.
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- Government agencies or departments responsible for administering WIA programs and services.
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- Any other party or entity involved in the implementation, monitoring, or evaluation of WIA-related activities.
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It is important to consult the specific guidelines or instructions provided by the relevant authorities or organizations to determine if the WIA-5 Rev 812 form is required in your particular situation.

What is WIA-5 (Rev 8/12) Form?

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WIA-5 Rev 812 is a form used to report workforce investment activities and outcomes.
Workforce investment agencies are required to file WIA-5 Rev 812.
WIA-5 Rev 812 can be filled out online or submitted electronically through the designated reporting system.
The purpose of WIA-5 Rev 812 is to track and evaluate the effectiveness of workforce investment programs.
Information such as participant demographics, training services provided, employment outcomes, and program performance measures must be reported on WIA-5 Rev 812.
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