HR ITA Voucher Form

HR ITA Voucher Form

Personal Information

Position Information

Reporting Manager:    |    Position Start Date:    |    Current Annual Salary: $

Training Request Details (ITA Voucher)

Cost Breakdown (Itemized)

Tuition/Fees: $    Travel/Mileage: $    Materials/Supplies: $

Other Costs (specify): Amount: $

Total Requested Funding: $    Employee Contribution: $    Scholarship/Other Funding: $

Employment History

Employer 1

Employer 2

Education

Professional References

Reference 1

Reference 2

Reference 3

Legal Disclosures & Authorizations

At-Will Employment: I understand and acknowledge that my employment is at-will and may be terminated by either the employer or me at any time, with or without cause or notice, subject to applicable law.

Equal Opportunity: The employer is an equal opportunity employer. Decisions regarding training approval, employment, promotion, and compensation are made without regard to protected classifications.

Background & Employment Verification Authorization: I authorize the employer or its agent to contact previous employers, educational institutions, and references to verify the information contained herein and to perform background checks as permitted by law. I understand that approval for funding may be conditioned on satisfactory verification.

Refund / Repayment Clause: If training is funded in whole or in part by the employer and I voluntarily separate employment or am separated for cause within the period specified by applicable policy, I may be required to reimburse the employer for unearned tuition or fees in accordance with company policy. By initialing, I acknowledge this provision:    Initials:

Data Privacy: I consent to the collection, use, and disclosure of personal information for the purposes of training administration, funding, and compliance with internal policy. Information will be retained in personnel and training records as required by policy.

Applicant Certification & Consent

I certify that all information provided on this form and in any attachments is true, complete, and accurate to the best of my knowledge. I understand that false statements or omissions may result in denial of funding or disciplinary action up to and including termination.

Consent to Verify: I authorize verification of statements, employment history, education, and references.

Consent to Background Check: I consent to any background checks required for participation in the training program.

Manager Recommendation (to be completed by Manager)

Manager Approves Funding:    Manager Name:

HR Use Only

Funding Approved:    Funding Source Code:

Applicant Acknowledgment

By signing below, I acknowledge that I have read and understand the policies governing training vouchers, that approval is subject to available funding and policy requirements, and that I accept responsibility for any employee-borne costs not approved in writing by HR. I agree to comply with reporting or completion requirements associated with this training.

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