Program Application

Please complete all required fields!

Applying For(*)

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Date of Application(*)

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Personal Information

First Name(*)

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Middle Name

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Last Name(*)

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Email(*)

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Home Phone(*)

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Address(*)

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State(*)

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City(*)

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Zip Code(*)

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Area of Interest(*)

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Write your SSN on the printed copy of this application or provide a copy of your SS card. If your SSN is missing, your application will be returned as incomplete.

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Check all that Apply

Check all that Apply to indicate Your Means of Qualifications for Apprenticeship(*)

Check all that Apply to indicate Your Means of Qualifications for Apprenticeship A. I believe I can meet all minimum qualifications for apprenticeship.
B. I can produce undisputable documentation to verify that I have at least 4,000 hours of electrical construction work experience.
C. I am currently performing electrical construction work for an electrical contractor who became signatory to a union contract. *enter name below
D. I am among the 50%, or more, who signed authorization cards while working for an electrical contractor during an organizing effort. *enter name below
E. I am attempting to qualify for, and participate in, the School-to-Registered-Apprenticeship Program.
F. I am attempting to transfer into this program from another IBEW/NECA registered apprenticeship program for the same trade.

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Name of Contractor (if C or D checked above)

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Education

Select the number of years of formal education you have completed(*)

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Are you a High School Graduate (or GED)?(*)

Are you a High School Graduate (or GED)? Yes No I have a GED

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List College Degrees Earned (if any)

Highest Degree Earned

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Second Highest Degree Earned

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Major

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Major

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School

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School

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Have you received one (1) full credit for Algebra, or some higher math course, from an accredited school?(*)

Have you received one (1) full credit for Algebra, or some higher math course, from an accredited school? Yes No

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Indicate Math course(s) completed

Indicate Math course(s) completed Algebra I
Algebra II
Geometry
Trigonometry
Calculus
NJATC Tech Math

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Have you completed any vocational/technical courses or training during or after high school?(*)

Have you completed any vocational/technical courses or training during or after high school? Yes No

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*If yes, list courses and/or training completed

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Background

Have you served in the US military?(*)

Have you served in the US military? Yes No

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*If Yes, how long? (in months)

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Military Branch

Military Branch Army
Navy
Air Force
Marines
Coast Guard
Military Reserves

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List which military training schools you completed, if any

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Have you ever been convicted of a felony? (Conviction will not automatically disqualify you.)(*)

Have you ever been convicted of a felony? (Conviction will not automatically disqualify you.) Yes No

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If yes, explain the conviction

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Do you have electrical construction work experience?(*)

Do you have electrical construction work experience? Yes No

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If yes, how many months?

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Do you have other construction work experience?(*)

Do you have other construction work experience? Yes No

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Do you have any electrical/electronic work experience?(*)

Do you have any electrical/electronic work experience? Yes No

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Have you applied with this apprenticeship program before?(*)

Have you applied with this apprenticeship program before? Yes No

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If yes, how many times?

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Are you now, or have you ever been, a registered apprentice?(*)

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

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If yes, list apprenticeship sponsor or employer

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If yes, are you still an active apprentice in that program?

If yes, are you still an active apprentice in that program? Yes No

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Do you have a valid Driver's License?(*)

Do you have a valid Driver's License? Yes No

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Do you have a Commercial Driver's License (CDL)?(*)

Do you have a Commercial Driver's License (CDL)? Yes No

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If yes, what class CDL do you have?

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Interests and Abilities

List the main reason or reasons, you are applying for this apprenticeship program(*)

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Are you physically and mentally able to safely perform or learn to safely perform essential functions of the job either with or without reasonable accommodations?(*)

Are you physically and mentally able to safely perform or learn to safely perform essential functions of the job either with or without reasonable accommodations? Yes No

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Are you able to get to and from work at job sites anywhere within the geographical area that this apprenticeship program covers?(*)

Are you able to get to and from work at job sites anywhere within the geographical area that this apprenticeship program covers? Yes No

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Are you able and willing to attend all related classroom training as required to complete your apprenticeship?(*)

Are you able and willing to attend all related classroom training as required to complete your apprenticeship? Yes No

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Are you able to climb and work from ladders, scaffolds, poles and towers of various heights?(*)

Are you able to climb and work from ladders, scaffolds, poles and towers of various heights? Yes No

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Are you able to crawl and work in confined spaces such as attics, manholes and crawlspaces?(*)

Are you able to crawl and work in confined spaces such as attics, manholes and crawlspaces? Yes No

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Are you able to read, hear, and understand instructions and warnings?(*)

Are you able to read, hear, and understand instructions and warnings? Yes No

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Work History

You must attach a Work History summary sheet indicating your present and previous employers, if any.

Are you presently employed?(*)

Are you presently employed? Yes No

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

If yes, do you request that we NOT contact your present employer at this time? Yes No

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Did you have any part-time or summer jobs while attending school?(*)

Did you have any part-time or summer jobs while attending school? Yes No

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Do you have the legal right to work in the United States of America?(*)

Do you have the legal right to work in the United States of America? Yes No

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Statements of Understanding

YOU MUST read each of the statements below to indicate your knowledge and understanding.
NOTE: If you need clarification on any item do not hesitate to ask.

Statements of Understanding

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 the program.

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 OFFICIAL transcripts and other required documents are provided in a timely manner. 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 application 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 be processed. In person signature required for application to be complete.

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. By checking the "I Agree" box below I 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, unless I have indicated otherwise. 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 (Apprentice Agreement).

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Statements of Understanding Agreement(*)

Statements of Understanding Agreement I agree

You must click "I Agree"