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Applicant Information

Apprenticeship Application Type
Social Security Address
Last Name
First Name City
Middle Initial State/Zip Code
Home Phone Email Address
Cell Phone Verify Email
Means of Qualification for Apprenticeship
    There are different methods to qualify for selection. Check all that apply to you.

Education

Highest Level of Education Completed






Have you completed any Vocational Technical courses or training during or after high school?
List Courses and/or Training Completed
Indicate Math Courses Completed






High School(s)
School Name
Location 
Date 
Degrees/Certificates Obtained 
Vocational/Technical School(s)
School Name 
Location 
Date 
Degrees/Certificates Obtained 
College(s)
School Name 
Location 
Date 
Degrees/Certificates Obtained 
Background

Have you served in the US military?
If YES, please enter dates.
Entry Date
Discharged
Which Branch?
List military training (MOS) you completed, if any.
Did you complete any school-to-career program?
If YES, what Program?
Do you have a valid Driver's License?
Do you have a Commercial Driver's License?
If Yes, what class CDL do you have? A, B, Other
Have you ever been convicted of a felony?
(Conviction will not automatically disqualify you; additional documentation may be required.)
If YES, explain the conviction.
Have you applied with this apprenticeship program before?
If YES, how many times?
Are you now, or have you ever been, a registered apprentice?
If Yes please complete the following:
Program Name
Location
Dates
Trade/Occupation
Degrees/Certificates
Are you still an active apprentice in that program?
Interest & Ability

List the main reasons for why you are applying for this apprenticeship program
Work History

Are you presently employed?
If Yes, do you request that we NOT contact your present employer at this time?
Do you have any of the following:
Electrical construction work experience?
Other construction work experience?
If Yes, provide details in the State your Job Title and Describe your Work section below.
1. Employer
Employer Address
Empl Phone
Employed From
Employed To
State your Job Title and Describe your Work
3. Employer
Employer Address
Empl Phone
Employed From
Employed To
State your Job Title and Describe your Work
2. Employer
Employer Address
Empl Phone
Employed From
Employed To
State your Job Title and Describe your Work
4. Employer
Employer Address
Empl Phone
Employed From
Employed To
State your Job Title and Describe your Work
Electrical/electronic/construction experience outside of your work experience?
If Yes, provide details on any other electrical or construction experience not described in your work experience (such as volunteer work, hobbies)
Safety Training or Certifications
Other Experience, Training, Skills or Awards. Describe any that you consider relevant to your Application.
Experience in Extreme and Strenuous Conditions. Identify or describe prior jobs or other experiences that involved extended time in extreme hot, cold or wet conditions, involving strenuous activities.
Identify or describe any jobs or experiences where you had to work high off the ground, deep in a trench or hole or do repetitive lifting and carrying of objects more than 50 pounds?
EEOC Supplemental Information

This apprenticeship sponsor is committed to equal opportunity for all applicants. The recruitment, selection, employment and training of apprentices during their apprenticeship, shall be without discrimination because of race, color, religion, national origin, sex or age, except the applicant must meet the minimum age requirement as specified in the standards. The JATC does not and will not discriminate against a qualified individual with a disability because of the disability of such individual.

This information voluntarily provided below is simply for equal employment opportunity commission (EEOC) purposes. This information will assist us in our efforts to provide accurate information in compliance with EEOC regulations and requirements.

Do you have any non-union work experience?
Have you ever worked as an IBEW CW/CE?
Ethnic Group
Ethnicity


Date Of Birth
Gender
How did you become aware of this apprenticeship opportunity?



If Other, please include additional information
Voluntary Disability Disclosure

Please check one of the boxes below:
Why are you being asked to complete this form?

Because we are a sponsor of a registered apprenticeship program and participate in the National Registered Apprenticeship System that is regulated by the U.S. Department of Labor, we must reach out to, enroll, and provide equal opportunity in apprenticeship to qualified people with disabilities.[1] To help us learn how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for apprenticeship, any answer you give will be kept private and will not be used against you in any way.

If you already are an apprentice within our registered apprenticeship program, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our apprentices at the time of enrollment, and then remind them yearly, that they may update their information. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obsessive compulsive disorder, impairments requiring the use of a wheelchair, intellectual disability (previously called mental retardation).

__________________
[1] Part 30 – Equal Employment Opportunity in Apprenticeship. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Apprenticeship website at https://www.doleta.gov/OA/eeo/.
Statements Of Understanding

Read the following and check that you understand and agree to each statement.
















I have checked all the above to indicate my understanding, and state that, to the best of my knowledge, all information provided on this form is true and accurate. I agree that any false statements made by me in this application shall constitute grounds for disqualification of my selection or grounds for my discharge, if false information is discovered after being selected for apprenticeship.

I hereby apply for an apprenticeship indenture with this sponsor and agree that if selected, I will abide by all Standards, Rules and Policies covered by the Indenture (Apprenticeship Agreement). Standards, Rules and Policy Detail Link.

Please provide your first name and last name between two forward slash "/" symbols in order to indicate your agreement to these terms. (Examples: /firstname lastname/, /John Doe/)
Digital Signature Date of Digital Signature

Captcha

Input the Characters from the image above then Click Verify CAPTCHA
Application Entry

In order to complete this application, please fill in all the information requested in this document.

Prior to submitting this document, you will be required to fill out the CAPTCHA (Completely Automatic Public Turing Test to Tell Computers and Humans Apart) before submitting this application.