NAME CHANGE: Please provide the name that will appear on documents or
transcripts that you submit, if it is different than your present name.
17. Are you physically and mentally able to safely perform or learn to
safely perform essential functions of the job either with or without reasonable
18. Are you able to get to and from work at job sites anywhere within
the geographical area that this apprenticeship program covers?
19. Are you able and willing to attend all related classroom training
as required to complete your apprenticeship?
20. Are you able to climb and work from ladders, scaffolds, poles and
towers of various heights?
21. Are you able to crawl and work in confined spaces such as attics,
manholes and crawlspaces?
22. Are you able to read, hear, and understand instructions and warnings?
You MUST Check Each Circle 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.
A. I am aware that it is my responsibility to keep this program informed
of any change in my address or phone number.
B. I have read and understand the basic qualifications for entry into
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.
D. I understand it is my responsibility to see that all transcripts and
other required documents are provided. If I fail to do so, my application
will become null and void.
E. I understand that interviews for qualified applicants will be conducted
in the order in which applications are completed.
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.
G. I understand that an incomplete or unsigned application form will NOT
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.
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.
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.
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, 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
---- 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.