Name: WCCA Government Affairs Committee Meeting
Start: 2022-12-28T14:00:00-07:00
End: 2022-12-28T15:30:00-07:00
Location: WCCA

General Background Information

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

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 *

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 *

Emergency Contact Information

Full Name *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Employment Status *

Employed
Unemployed / Not Working

Current Employer Information

Organization *

Address *

Address Line 1

Address Line 2

City

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 *

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 *

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 *

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 *

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 *

I am aware that this occupation could involve the lifting of heavy objects, working in confined areas and working in high places.

Initial *

I will comply with drug testing enforcement based on employer/Apprentice agreement.

Initial *

Tuition/fee of $3700.00 is payable on acceptance into WCCA Apprenticeship Program.

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 *

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.

General Background Information

Emergency Contact Information

Current Employer Information

Job Related Experience

Apprenticeship Conditions

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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