To: Next Level Jobs Program INVOICE NUMBER:

Department of Workforce Development Invoice Date: mm/dd/yyyy

Attn: Employer Engagement

10 N Senate Ave Total Award Amount:

Indianapolis, IN  46204

317‐232‐6698

nextleveljobs@dwd.in.gov

Grant Title:

SSN (last four 

digits)

Birth Date 

(mm/dd/yy)

Occupation (Must be 

from occupation list: 

http://www.nextleveljo

bs.org/Eligible‐

occupations.pdf) Name of training

Hire Date 

(mm/dd/yy)

Training Period 

Begin Date 

(mm/dd/yy)

Wage at start of 

Training/Wage 

at completion of 

Training    

Six month 

retention date 

(mm/dd/yy)

Training Cost for 

this employee 

(Not to exceed 

$5,000.)

Total Due This Invoice:

Employer Training Balance

Grantee Printed Name

Please Remit Payment To:  Date:

EmployerGrantee Signature (mm/dd/yyyy)

Address 1

Address 2DWD Approver Printed Name

Address 3 Date:

TelephoneDWD Approver Signature (mm/dd/yyyy)

Invoice – Next Level JobsState Form 56566 (8-18)Approved by State Board of Accounts, 2018Approved by Auditor of State, 2018

Cannot exceed $50,000. 

Must equal total in cell K45.

Employer Training Grant

Employee Name (first, last)

I certify that all expenditures reported or payment requested are for appropriate purposes and in 

accordance with the provisions of the employer training  guidelines and voucher. I hereby certify that 

the foregoing information is accurate, activities have been performed in accordance with programs, 

guidelines and the amount claimed is legally due, after allowing all just credits and that no part of the 

same has been paid.