APPRENTICESHIP APPLICATION

For office use only

Sponsor Program Number or Code _PA2480__ Application Number

Program Type: Inside Wireman

The remainder of this form is to be completed entirely by the applicant.

Please complete the application and forward to the apprentice office.

Email: jatfan@comcast.net

Mail: Apprentice Office, 20 Morgan Drive, Reading, PA 19608

There is also a drop box in the vestibule at our physical location.

Please be reminded your application is not complete without your high school/GED transcripts

Our website is: 743electricaltraining.org

DATE OF APPLICATION:
FIRST NAME:
LAST NAME:
ADDRESS:
CITY:
STATE:
ZIP:
CELL PHONE:
EMAIL:
SOCIAL SECURITY NUMBER:

List the main reason or reasons, you are applying for this apprenticeship program.

Have you applied with this apprenticeship program before?	Yes No

a. If Yes, how many times?	Times:

b. Are you now, or have you ever been, a registered apprentice?	Yes	No

If Yes, list apprenticeship sponsor or employer:

There are different methods to qualify for selection. Check all that apply to you.

I believe I can meet all minimum qualifications for apprenticeship.

I can produce undisputable documentation to verify that I have at least 4,000 hours of electrical construction work experience.

I can produce undisputable documentation to verify that I have at least 2,000 hours of electrical construction work experience.

I am currently performing electrical construction work for an electrical contractor who became signatory to a union contract. The name of the contractor is:

I am among the 30% or more, who signed authorization cards while working for an electrical contractor during an organizing effort. The name of the contactor is:

I am attempting to qualify for, and participate in, the School-to-Registered-Apprenticeship Program.

I am attempting to qualify for this program with military experience and/or military honorable discharge.

I am attempting to qualify from the completion of a registered/authorized pre-apprenticeship program.

I am attempting to qualify from completion of the electrical training ALLIANCE Interim Credentials.

I am attempting to qualify with Line School or Line College completion certificate.

I am attempting to transfer into this program from another IBEW-NECA registered apprenticeship program for the same trade.

EDUCATION

Check the years of formal education you have completed.

<10 10 11 12 Associates Degree Bachelor’s Degree

Are you a High School Graduate?	Yes No

If no, do you have a GED?	Yes No

List College Degree(s) earned, including Degree, Major and School.

Indicate Math courses completed.

Algebra 1 Algebra II Geometry Trigonometry Calculus

NJATC Tech Math

Have you completed any vocational technical courses or training during or after high school

Yes No

List courses and/or training completed.

WORK HISTORY

Are you presently employed?	Yes	No

If Yes, do you request that we NOT contact your present employer at this time?

Yes No

Do you have any of the following? If Yes, also provide details on the work history experience summary sheet.

Electrical construction experience?

Other construction work experience?

Electrical/electronic/construction experience outside of your work experience?

OTHER BACKGROUND

Have you served in the U.S. military? Yes No

If Yes, you MUST provide a DD214 or equivalent form for your branch of service.

Have you ever been convicted of a felony? (Conviction will not automatically disqualify you; additional documentation may be required). Yes No

If Yes, explain the conviction:

The Standards for this Program require: [Program to check any that apply]

Valid Driver’s License XX	Commercial Driver’s License (CDL) Not required

Do you hold the license(s) checked?	Yes No

STATEMENTS OF UNDERSTANDING

Read the following and initial after each statement indicating you understand and agree to each statement.

I am aware that it is my responsibility to keep this program informed of any change in my address or phone number. ____

I have read and understand the basic qualifications for entry into the program that have been provided to me and believe that I meet them. ____

I understand that I must furnish certain documentation to show that I meet the qualifications required for entry into the pool of eligible candidates for this apprenticeship, and that it is my responsibility to see that my OFFICIAL transcript and other required documents are provided in a timely manner. ____

I am willing and able to attend all related classroom training as required to complete this apprenticeship. ____

I understand that I must be able to get to and from work at job sites anywhere within the geographical area that this apprenticeship program covers. ____

I have reviewed the Rules for this Program and am able to meet them. I agree that if selected, I will abide by all of the sponsor’s Standards, Rules and Policies and the Apprenticeship Agreement (please click to review) RULES POLICY ONLINE APPLICANTS.doc ____

I understand that as a condition of participation in this program I will need to have and maintain the legal right to work in the U.S., and to verify this to contractors. ____

I understand that I must be physically and mentally able to safely perform or learn to safely perform the essential functions of the job of an electrical worker in the type of program for which I am applying, either with or without reasonable accommodations; and that the necessary abilities typically include the following: repetitively lift and carry more than 50 pounds; climb and work from ladders, scaffolds, poles and towers of various heights; crawl and work in confined spaces such as attics, manholes and crawlspaces; and to read, hear, and understand instructions and warnings in English. ____

I understand that interviews for qualified applicants will be conducted in the order in which applications are completed. ____

I confirm that all information provided on this Application and in any supporting documentation provided by me is true, accurate and complete. I understand that any false or inaccurate information or material omissions in any of the information provided by me in connection with this application shall be just cause for denial of oral interview, disqualification of my selection or, if discovered after being selected for apprenticeship, my termination from the Program. ____

I understand that an incomplete or unsigned application form will NOT be processed. ____

I understand that if selected for the apprenticeship program such a selection may be conditioned upon successfully completing additional steps that are set forth in this Program’s Standards and Selections Procedures, and that these may include a physical examination or other medical inquiries; drug testing; additional documentation of my background; a background check; a boot camp; or other pre-indenture requirements. ____

I understand that if this application is being completed manually that only an ORIGINAL application will be processed, and that Photocopies are NOT acceptable. ____

I 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. ____

By putting my initials next to these statements and signing below I confirm that I have read, understood and agree to these statements and I apply for an apprenticeship with this sponsor.

SIGNED:	DATE:

APPRENTICESHIP APPLICATION SUPPLEMENT

EDUCATION

High School or GED
You must obtain and provide official transcripts from your high school/GED for application to be complete
Location
From: To:
Degrees/Certificates Obtained

Vocational / Technical School
Location
From: To:
Degrees/Certificates Obtained

Apprentice Training
Location
From: To:
Degrees/Certificates Obtained

College
Location
From: To:
Degrees/Certificates Obtained

Military Service
Branch
From: To:
Special Training or Experience

WORK EXPERIENCE

Indicate your present and previous employers. Identify any positions that involved electrical or construction industry experience. You will need to provide documentation of electrical industry experience to receive credit.

(You do not need to complete this page if you are attaching a resume.)

Employer:
Address:
Phone:
From:
To:
Your Job Duties:

Employer:
Address:
Phone:
From:
To:
Your Job Duties:

Employer:
Address:
Phone:
From:
To:
Your Job Duties:

WORK HISTORY / EXPERIENCE SUMMARY SHEET

Electrical or Construction Experience

Describe 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?

Program Registration and	U.S. Department of Labor

Apprenticeship Agreement	Employment and Training Administration

Office of Apprenticeship

Voluntary Disability Disclosure	OMB No. 1205-0223 Expires: 01/31/2020

Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Your name:

Date:

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/. ETA 671 – Section II

Apprenticeship Application EEOC Supplemental

Informational Form

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 (including pregnancy and gender identity), sexual orientation, genetic information or because they are an individual with a disability or a person 40 years old or older.

We respectively request that you complete this form for the apprenticeship. The information voluntarily provided is simply for Equal Employment Opportunity Commission purposes. This information will assist us in our efforts to provide accurate information in compliance with EEOC regulations and requirements.

Please complete the following:

Name:

Gender:	Male

Female

Date of Birth:	/	/

(xx/xx/xxxx format)

Race:	American Indian or Alaskan Native

Asian or Pacific Islander

Black

White

Ethnic Group:	Hispanic Origin

Not of Hispanic Origin