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Heavy Equipment Operators Apprenticeship Application
Heavy Equipment Operators Apprenticeship Application
wccagjstg
2022-09-09T12:29:27-06:00
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General Background Information
Name
*
First
Middle
Last
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone
*
Personal Email
*
Education Level (9th-12th grade OR GED)
*
County
*
Date of Birth
*
Social Security Number
Drivers License Number
*
Drivers License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License Expiration Date
*
Are you 18 Or Older?
*
Yes
No
Have you applied for this apprenticeship program before?
*
Yes
No
Are you a United States Citizen or legally authorized to work in the United States?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
A conviction record will not necessarily be a bar to acceptance, but may be relevant if job related. If marked YES please provide details in separate confidential letter
Do you have prior military service?
*
Yes
No
Date of Discharge
Length of Service
Describe duties or experience which may be useful for consideration of apprenticeship.
Sex
*
Male
Female
Prefer not to answer
Veteran Status
*
Veteran
Non-Veteran
Ethnic Group
*
Hispanic or Latino
Non-Hispanic or Latino
Prefer not to answer
Race
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Prefer not to answer
Emergency Contact Information
Full Name
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Employment Status
*
Employed
Unemployed / Not Working
Current Employer Information
Organization
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Length of Employment
*
List from date and to date.
Hours Per Week
*
Wage Rate
*
Supervisor Name
*
Supervisor Phone Number
*
Major Activities
*
Machines/Equipment Used
*
Job Related Experience
Please describe any trade and/or construction work experience you have including specific duties you performed.
Apprenticeship Conditions
Initial
*
Clear Signature
I am aware that in this construction trade, you must travel to various construction projects within numerous counties covered by this apprenticeship program. I must have reliable means of transportation to travel to these projects.
Initial
*
Clear Signature
I am aware that this apprentice program has attendance of at least 144 hours per year of related training in addition to your normal working hours. I will be required to attend these related training classes without monetary compensation, even if those classes are held during a normal working day.
Initial
*
Clear Signature
I am aware that employment in this trade may not be full time and there may be periods of unemployment due to weather, economic conditions and other circumstances.
Initial
*
Clear Signature
I am aware that apprentices start at a percentage of journeyman rate and receive periodic increases. These increases are not automatic but depend on the progress made by the apprentice in on-the-job training and related training.
Initial
*
Clear Signature
I am aware that this occupation could involve the lifting of heavy objects, working in confined areas and working in high places.
Initial
*
Clear Signature
I will comply with drug testing enforcement based on employer/Apprentice agreement.
Initial
*
Clear Signature
Tuition/fee of $3700.00 is payable on acceptance into WCCA Apprenticeship Program.
Signature
*
Clear Signature
The Western Colorado Contractors Association ATC will not discriminate against apprenticeship applicants or apprentices based on 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. The Western Colorado Contractors Association ATC will take affirmative action to provide equal opportunity in apprenticeship and will operate the apprenticeship program as required under Title 29 of the Code of Federal Regulations, part 30.
I authorize investigation of all statements contained herein and authorize my former employers, references and/or schools I have attended to release any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same.
Date
*
Signature
*
Clear Signature
I have read and understand these apprenticeship conditions and I declare that any statement in this application and other information provided is true and complete. I also authorize the verification of information provided except where specifically noted otherwise.
Date
*
Applicant’s information is confidential. Application is pending acceptance and does not guarantee placement in program until approved by WCCA and Dept. of Labor.
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