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WIOA5 (12/15)ELIGIBILITY AND CERTIFICATION FOR DISLOCATED WORKERSName:SSN:Phone(s):Address:1. Email Address:
American Job Center:
Eligibility Criteria (Check Appropriate Eligibility Category (1, 2,
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What is eligibility and certification for?
Eligibility and certification is used to determine if an individual meets the requirements for a specific program or benefit.
Who is required to file eligibility and certification for?
Individuals who are seeking to receive a particular benefit or participate in a specific program may be required to file eligibility and certification.
How to fill out eligibility and certification for?
Eligibility and certification forms can be filled out by providing the requested information accurately and completely.
What is the purpose of eligibility and certification for?
The purpose of eligibility and certification is to verify that individuals meet the criteria set forth by a program or benefit.
What information must be reported on eligibility and certification for?
Information such as income, residency, and other eligibility criteria may need to be reported on eligibility and certification forms.
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