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Application Type	Electrician, Construction (Inside Wireman)Sound & Communication Apprentice
Last 4 Digits of SSN		Address
Last Name
First Name		City
Middle Initial		State/Zip Code
Home Phone		Email Address
Cell Phone		Verify Email

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Highest Year of Education Completed	High School(s)
Completed Highschool Completed Ged Completed 1 Year Of College Completed 2 Years Of College Completed 3 Years Of College Completed 4 Or More Years Of College
	College(s) or Vocational School(s)

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Yes No Do you have any trade experience? Yes No Have you applied with this apprenticeship program before? If YES, how many times? Yes No Have you participated in an apprenticeship of any kind? If YES, in what? Yes No Do you have a valid Driver's License? License #

Yes No Did you complete any school-to-career program? If YES, what Program? Yes No 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.

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List the reason(s) why you are applying for this apprenticeship program:

Check All That Apply

Physically And Mentally Able To Perform The Work Of This Trade With Or Without Reasonable Accommodations Have Reliable Transportation To Get Anywhere In The Central Valley Willing And Able To Attend All Classes As Required Able To Climb Ladders, Scaffolds Or Towers Of Various Lenghts And Heights Able To Crawl And Work In Confined Spaces Such As Attics, Manholes Or Crawl Spaces Able To Read And Understand English Able To Hear And Understand Verbal Instructions And Warnings In English Able To Work In Various Climatic Conditions, Such As Extreme Heat Or Cold

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1. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

2. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

3. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

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1. Reference Name		Relationship
Reference Occupation		Address
If this reference was a supervisor, list your last title with this employer.
		Phone Number

2. Reference Name		Relationship
Reference Occupation		Address
If this reference was a supervisor, list your last title with this employer.
		Phone Number

3. Reference Name		Relationship
Reference Occupation		Address
If this reference was a supervisor, list your last title with this employer.
		Phone Number

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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.

Date Of Birth	Number of Dependents	Number of Years You Have Been Employed in any Occupation Full-Time to Date (Except for Military Service)
	None	None
	One	Less Than 1 Year
Gender	Two	Year 1 But Less Than 2
Female Male	Three	2 But Less Than 3 Years
	Four	3 But Less Than 4 Years
	Five	4 But Less Thans 5 Years
	Six or More	5 Years or More

Ethnicity

Caucasian / White Asian Hmong Asian Malaysian Asian Vietnamese Native Hawaiian Samoan African American Asian Indian Asian Pakistani Native Hawaiian Fijian Native Hawaiian Tongan Asian Cambodian Asian Japanese Asian Sri Lankan Native Hawaiian Guamanian American Indian Or Alaskan Native Asian Chinese Asian Korean Asian Taiwanese Native Hawaiian Hawaiian Hispanic Asian Filipino Asian Laotian Asian Thai

How did you become aware of this apprenticeship opportunity?

Someone In The Trade Newspaper Advertising Through School/counselor Word Of Mouth Other Internet Through A Pre-Apprenticeship Program Television Advertising Through A Job Placement Program

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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

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/.

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You must check ALL the Boxes. If you need clarification on any item contact Fresno, Madera, Kings and Tulare Counties Electrical JATC.

I Am Legally Able To Work In The United States I Understand 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 I Understand What Is Required To Complete This Application And Become Qualified For Oral Interview I Understand That I Must Furnish Documentation To Provide Evidence That I Do Meet The Qualification Required For Entry Into The Pool Of Eligible Candidates For This Apprenticeship I Understand That It Is My Responsibility To Furnish Official Transcripts And A Valid I D In A Timely Manner In Order To Complete My Application I Understand That I Cannot Qualify For Testing Or Interview Until I Have Met The Minimum Basic Qualification And Have Provided The Necessary Transcripts And Documents As Required I Understand That Interviews For Qualified Applicants Will Be Conducted In The Order In Which The Applications Are Completed I Understand That Any Intentional Falso Statement Or Information I Have Provided On This Application Form Or On Other Documents Shall Be Cause For Denial Of Oral Interview Or Termination Of Indenture, Should I Be Selected For The Program I Understand That An Incomplete Application Form Will Not Be Processed I Understand That If Selected, I Will Be Required To Complete The Selection Process By Passing A Drug Test Before Signing Any Indenture Forms

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 hereby grant permission to all former employers and references listed to disclose any information concerning my past employment and/or qualifications. 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).

Please provide your firstname and lastname 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