Apprenticeship Application "*" indicates required fields Personal InformationName* First Middle Inital Last SSN*Email* Mobile Phone*Home PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you 18 or older?* Yes No Date of Birth* MM slash DD slash YYYY Military service?* Yes No Branch* Length of Service* Type of Discharge* Date of Discharge* MM slash DD slash YYYY Attach Military DocumentTransfer or discharge form DD-214, if applicableMax. file size: 15 MB.Are you a veteran?* Yes No War* How did you hear about this position?* Date available* MM slash DD slash YYYY Prior Work ExperienceCurrent or Most RecentEmployer* Immediate Supervisor PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Position/Job Title* Pay Reason for Leaving* May We Contact?* Yes No PriorEmployer* Immediate Supervisor PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Position/Job Title* Pay Reason for Leaving* May We Contact?* Yes No PriorEmployer* Immediate Supervisor PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Position/Job Title* Pay Reason for Leaving* May We Contact?* Yes No EducationHigh SchoolName/Location Last Year Completed Degree Major or Emphasis College/UniversityName/Location Last Year Completed Degree Major or Emphasis Trade SchoolName/Location Last Year Completed Degree Major or Emphasis G.E.D.Name/Location Last Year Completed Degree Major or Emphasis List any applicable special skills, training or proficiencies* Consent* I, the Undersigned, have read, understand, and agree to abide by the qualifications and requirements for a probationary apprenticeship.Qualifications necessary for an applicant to be considered for a probationary pipe trades apprenticeship: 1. Must be 18 years of age. (see Section I11-8-2-Qualifications of Applicants for Apprenticeship in the National GuIideline Standards of Apprenticeship): 2. Complete this application and submit with the following: • Birth certificate or other such document for proof of age. • High School diploma and transcript or high school equivalency (GED) certification and Official report of test results. • Military transfer or discharge Form DD-214, if applicable: 3. Appear for interview when notified. If you are accepted for a probationary apprenticeship you will be required to: 1. Serve as a probationary apprentice for a period of 1 year (1700-2000 hours of on-the-job training): 2. Serve a 5 year apprenticeship including the probationary period (8500-10000 hours of on-the-job training); 3. Report for work on a regular basis; 4. Provide for your transportation to and from the job site; 5. Work under the direction of a Journey Worker on the job site and perform job duties satisfactorily; 6. Attend related training classes regularly and maintain an acceptable average in those classes; 7. Purchase text material for use in related training classes as required; 8. Abide by all rules and regulations of the Joint Apprenticeship and Training Committee.Attach DocumentsBirth certificate, transcripts/GED, ACCUPLACER/ACT scores, etc. Drop files here or Select files Max. file size: 25 MB. Signature*Disclaimer: By signing, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records. EEOC Supplemental InformationThe Apprentice 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, age, creed, handicap, marital status, ancestry, sexual orientation, arrest record, conviction record, or membership in the military forces of the United States or this state. The sponsor will take affirmative action to provide equal opportunity in apprenticeship and will operate the apprenticeship program as requires under title 29 of the code of Federal Regulations, Part 30, the Wisconsin Fair Employment Law, and all other applicable state laws. This information 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. RaceCheck all that apply White Black Asian American Indian or Alaskan Native Hawaiian/Pacific Islander Ethnic Group Not Hispanic or Latino Origin Hispanic or Latino Gender Male Female This form will not become part of your Personnel file. It will be maintained in a separate file, used only for EEOC and Affirmative Action reporting purposes.NameThis field is for validation purposes and should be left unchanged. 24944
