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Application

 
 

YEAR LOG #

APPLICATION FOR APPRENTICESHIP

E-Mail:
LAST NAME FIRST NAME MIDDLE INITIAL:
ADDRESS:
CITY: STATE: ZIPCODE:
PHONE NUMBER: CELL PHONE:


Person(s) to contact in case of emergency (MUST BE COMPLETED)
Name and Telephone Number
If hired, can you submit proof of age? Yes No
EDUCATION: 7th Grade or Less 9th Grade to 12th Grade
Name of High School Attended: City &
Year Graduated: (If Applicable)
If offered Job, and prior to your being employed, are you willing to take a physical examination, if required? Yes - or No
Are you able to work in: Temperature Extremes
  Dusty Conditions
  Cramped Quarters
  High Places

Have you had previous experience in this Trade? If so, briefly explain:

List other jobs or occupational training you have received, i.e.: correspondence courses, trade school, armed forces, apprenticeship or other job training:

List previous employment record (start with present employer):
 
COMPANY
LOCATION
KIND OF WORK
DATES (FROM-TO)
Employer 1
Employer 2
Employer 3

Why have you chosen this trade for your future career?

How did you hear about Apprenticeship Program?

Do you understand that if accepted:
You will be on probation for the first six months of you apprenticeship?
You will be required to submit a Monthly Work Report on your on-the-job training?
You will be required to successfully complete at least 204 hours of related technical instruction each year during your apprenticeship?
Satisfactory completion of both the on-the- job training and related study requirements must be met before you will be recognized as completing and receive a “Certificate of Completion of Apprenticeship”?
Failure to comply with any rules/ regulations could mean suspension and/ or termination from the program.
You must provide your own transportation to the job site and related instruction weekend classes?

Have you ever been fired by an employer? Yes No . If yes briefly explain the reason:

Have you ever been convicted of a misdemeanor? Yes No . Or a felony? Yes No . If yes, briefly explain the nature of the conviction:

Are you receiving credit for previous experience and training? Yes No
(If requesting credit for previous experience and training outside the supervision of this Apprenticeship Program you must furnish such records and other bona fide evidence as the Apprenticeship Program Sponsor may require to substantiate your claim.)


PRIVACY ACT STATEMENT

This information requested below is used for program statistical purposes only and and may not be used otherwise disclosed without the express permission of the undersigned.
(Privacy Act of 1974- P.L. 93-579)

 
 
Race/Ethnic Compositions:
 
Sex:
 
Veteran:
 
         
  White (Not Hispanic) Male Vietnam 8/64-5/75  
  Black (Not Hispanic) Female Other Vet  
  Hispanic   Non Vet  
  Asian/Pacific Islanders      
  American Indian or Alaskan Native      

Attention: Form must be complete!

 
     
       
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