Apprenticeship Application This application requires a $25 application fee. Upon hitting the Submit button below you will be sent to the application fee payment area on Union.ly.Name(Required) First Middle Last Address(Required) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number(Required)Email(Required) Last 4 Numbers of Social Security #(Required)NAME CHANGE: Please provide the name that will appear on documents or transcripts that you submit, if it is different than your present name. First Last Required Information Must Be Provided to Complete this Application1. Check the Appropriate box(es) (A-D) to Indicate Your Means of Qualification for Apprenticeship. A. I believe I can meet all minimum qualifications for apprenticeship. B. I can produce undisputable documentation to verify that I have at least 4,000 hours of electrical construction work experience. C. I am currently performing electrical construction work for an electrical contractor who became signatory to a union contract. 1C: The name of the contractor is: 1. Check the Appropriate box(es) (A-F) to Indicate Your Means of Qualification for Apprenticeship. D. I am attempting to transfer into this program from another IBEW/NECA registered apprenticeship program for the same trade. Education2. Fill in the Circle to indicate the years of formal education you have completed: <10 10 11 12 13 14 15 16 17 18 >18 3. Are you a High School Graduate? Yes No If NO, do you have a GED? Yes No 4. List College Degree(s) earnedDegreeMajorSchool Add RemoveClick on the + to add multiple degrees earned.5. Have you received one (1) full credit of Algebra, or some higher math course, from an accredited school? Yes No 5a. Indicate Math course(s) completed: Algebra 1 Algebra 2 Geometry Trigonometry Calculus NJATC Tech Math 6. Have you completed any vocational/technical courses or training during or after high school? Yes No 6a. List Courses and / or training completed: Add RemoveClick on + to add additional courses or trainingBackground7. Have you served in the US military? Yes No 7a. If YES, how long? In Months: 7b. Which Branch?7b. Which Branch? Army Navy Air Force Marines Coast Guard Military Reserve 7c. List which military training schools you completed Add RemoveClick on the + to add additional schools8. Do you have electrical construction work experience? Yes No 8a. If yes, how many months? 9. Do you have other construction work experience? Yes No 10. Do you have any electrical/electronic work experience? Yes No 11. Have you applied with this apprenticeship program before? Yes No 11a. If YES, how many times? 12. Are you now, or have you ever been, a registered apprentice? Yes No 12a. If YES, list apprenticeship sponsor or employer Add RemoveClick on the + to add additional12b. If YES, are you still an active apprentice in that program? 13. Do you have a valid Driver's License? Yes No 14. Do you have a Commercial Driver's License (CDL)? Yes No 14a. If YES, what class CDL do you have? Interests and Abilities15. List the main reason or reasons, you are applying for this apprenticeship program.16. Are you physically and mentally able to safely perform or learn to safely perform essential functions of the job either with or without reasonable accommodations? Yes No 17. Are you able to get to and from work at job sites anywhere within the geographical area that this apprenticeship program covers? Yes No 18. Are you able and willing to attend all related classroom training as required to complete your apprenticeship? Yes No 19. Are you able to climb and work from ladders, scaffolds, poles and towers of various heights? Yes No 20. Are you able to crawl and work in confined spaces such as attics, manholes and crawlspaces? Yes No 21. Are you able to read, hear, and understand instructions and warnings? Yes No Work History22. Previous WorkEmployerRole & Duties Add RemoveClick on + to add additional information23. Are you presently employed? Yes No 23a. If YES, do you request that we NOT contact your present employer at this time? 24. Did you have any part-time or summer jobs while attending school? Yes No 25. Do you have the legal right to work in the United States of America? Yes No Statements of UnderstandingYou MUST Check for Each of the Statements (A through I) Below to Indicate Your Knowledge and Understanding. NOTE: If You Need Clarification On Any Item Do NOT Hesitate to Ask Us. Yes A. I am aware that it is my responsibility to keep this program informed of any change in my address or phone number. Yes B. I have read and understand the basic qualifications for entry into the program. Yes C. I understand that I must furnish certain specific documentation to provide evidence that I meet the qualifications required for entry into the pool of eligible candidates for this apprenticeship. Yes D. I understand it is my responsibility to see that all OFFICIAL transcripts and other required documents are provided in a timely manner. If I fail to do so, my application will become null and void. Yes E. I understand that interviews for qualified applicants will be conducted in the order in which applications are completed. Yes F. I understand that any false information provided as part of my applications shall be just cause for denial of oral interview, or termination of my apprenticeship indenture agreement, should I be selected for the program. Yes G. I understand that an incomplete or unsigned application form will NOT be processed. Yes H. I understand that if selected for the apprenticeship program, such a selection may be conditioned by the sponsor on successfully completing additional steps, including a physical examination or other medical inquiries, drug testing, and/or a background check before signing an indenture. Yes I. I understand that only this ORIGINAL application form will be processed, and that Photocopies are NOT acceptable. I have checked all the above (A thru I) to indicate my understanding, and state that all information provided on this form is true and accurate. I hereby grant permission to all former employers and references listed to disclose any information concerning my past employment and/or qualifications, unless I have indicated otherwise(23a.). I agree that any false statements made by me on this application form 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 of the sponsor's Standards, Rules and Policies and the Indenture (Apprenticeship Agreement). Type in your name in the box below as your signature to these statements.Type Full Name(Required) HiddenApprenticeship Application EEOC Supplemental InformationTHIS 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, GENDER OR AGE - EXCEPT THAT THE APPLICANT MUST MEET THE MINIMUM AGE REQUIREMENT. THE JATC DOES NOT, AND WILL NOT, DISCRIMINATE BECAUSE OF THE DISABILITY OF SUCH INDIVIDUAL. WE RESPECTFULLY REQUEST THAT YOU ANSWER THESE QUESTIONS AS PART OF YOUR APPLICATION FOR APPRENTICESHIP. PLEASE COMPLETE THE FOLLOWING THE 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.HiddenRace American Indian or Alaskan Native Asian or Pacific Islander Black White Choose not to Identify HiddenGender Male Female Choose not to Identify How did you become aware of this apprenticeship opportunity? Word of Mouth TV Career Day Posted Announcement Guidance Counselor Teacher/Instructor Radio Newspaper Other If you checked other please tell us where: Voluntary Disability Disclosure Yes, I have a Disability (or previously had a disability) No, I don't have a disability I don't wish to answer Please Note:You will need to submit a copy of your driver’s license and high school transcripts.These can be dropped off in person, emailed to Julie Strike (firstname.lastname@example.org), or faxed (507) 361-2291.Upon hitting the Submit button below you will be sent to the application fee payment area on Union.ly. Simply select the application fee and process the checkout and payment.