Applications
PERSONAL INFORMATION
First Name: *
Middle Name:
Last Name: *
Address: *
Address 2:
City: *
State: *
Postal Code: *
Country: *
Day Phone:
Eve Phone:
Cell Phone:  *
Other:
Email: *
SSN: *
Information is stored encrypted.
Information Education and Background
Must upload a copy of the following: Birth Certificate High School Diploma Official High School transcript or GED test scores Driver's License Social Security Card Military DD-214 (if applicable)
Question Answer Notes Image Upload File
Date of Birth (upload birth certificate) *
 *
No file chosen
Highest Year of Education Completed
Date of High School Diploma or GED (upload high school diploma or GED)
 *
No file chosen
Other Certificate of Education from another source (upload a copy)
No file chosen
DD 214 from the Military Service (upload copy of DD214)
No file chosen
Social Security Card (upload a copy) *
 *
No file chosen
Background
Question Answer Notes Image Upload File
Have you ever been convicted of a felony?
If Yes, explain the conviction (conviction will not automatically disqualify you)
Do you have any Trade experience?
Have you applied with this Apprenticeship program before?
If Yes, How many times have you applied?
Have you participated in an Apprenticeship of any kind?
Did you complete any school-to-career program?
If Yes, please explain what program
Have you served in the US Military?
Military Entry Date
Military Discharge Date
Which Branch of Military Service?
List Military training (MOS) you completed, if any.
Do you have a Valid Driver's License (please upload a copy)? *
 *
No file chosen
Driver's License #
Interest & Ability
Question Answer Notes Image Upload File
Are you able to understand verbal instructions or warnings given in English?
Are you available to work full time?
Are you able and willing to attend classes two nights per week?
Are you able to get to and from work at various job sites within the Birmingham or Gadsden area?
Are you Physically and Mentally able to perform the work of this Trade, either with or without reasonable accommodations?
List the reason(s) why you are applying for this Apprenticeship program
Employment History
Current Employer
Question Answer Notes Image Upload File
Company Name
Company Phone#
Company Address
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
Previous Employer
Question Answer Notes Image Upload File
Company Name
Company Address
Company Phone#
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
Employer
Question Answer Notes Image Upload File
Company Name
Company Address
Company Phone#
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
References
Reference 1
Question Answer Notes Image Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
Reference 2
Question Answer Notes Image Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
Reference 3
Question Answer Notes Image Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
EEOC Supplemental Information
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.
Question Answer Notes Image Upload File
How did you become aware of this Apprenticeship opportunity?
Number of years you have been employed in any occupation full-time to date (except military service)
Ethnicity
Number of Dependents
Statements of Understanding
You must answer ALL. If you need clarification on any item contact Local 91 JA Center
Question Answer Notes Image Upload File
I am legally able to work in the United States
I understand that if accepted I will be subject to a drug test
I understand that any intentional false or misleading information will make me ineligible for the program
I understand that submitting an application is not a guarantee of employment or of acceptance into the program
I understand that my application is not complete until I have paid the Application fee and turned in all required documentation
I have read and meet the basic qualifications for entry into this program
I understand that it is my responsibility to keep the school informed of any changes in my address or phone number
Signature and Disclaimer
I have checked all the above to indicate my understanding, and state that, to the best of my knowledge, all information concerning my past 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).
Question Answer Notes Image Upload File
Signature *
Signature Date *

Review your signature

Draw your signature

I agree to the term of this application and I understand that this signature is a binding signature.
PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
Address:
Address 2:
City:
State:
Postal Code:
Country:
Day Phone:
Eve Phone:
Cell Phone:
Other:
Email:
SSN:
Information Education and Background
Must upload a copy of the following: Birth Certificate High School Diploma Official High School transcript or GED test scores Driver's License Social Security Card Military DD-214 (if applicable)
Question Answer Upload File
Date of Birth (upload birth certificate)
Highest Year of Education Completed
Date of High School Diploma or GED (upload high school diploma or GED)
Other Certificate of Education from another source (upload a copy)
DD 214 from the Military Service (upload copy of DD214)
Social Security Card (upload a copy)
Background
Question Answer Upload File
Have you ever been convicted of a felony?
If Yes, explain the conviction (conviction will not automatically disqualify you)
Do you have any Trade experience?
Have you applied with this Apprenticeship program before?
If Yes, How many times have you applied?
Have you participated in an Apprenticeship of any kind?
Did you complete any school-to-career program?
If Yes, please explain what program
Have you served in the US Military?
Military Entry Date
Military Discharge Date
Which Branch of Military Service?
List Military training (MOS) you completed, if any.
Do you have a Valid Driver's License (please upload a copy)?
Driver's License #
Interest & Ability
Question Answer Upload File
Are you able to understand verbal instructions or warnings given in English?
Are you available to work full time?
Are you able and willing to attend classes two nights per week?
Are you able to get to and from work at various job sites within the Birmingham or Gadsden area?
Are you Physically and Mentally able to perform the work of this Trade, either with or without reasonable accommodations?
List the reason(s) why you are applying for this Apprenticeship program
Employment History
Current Employer
Question Answer Upload File
Company Name
Company Phone#
Company Address
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
Previous Employer
Question Answer Upload File
Company Name
Company Address
Company Phone#
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
Employer
Question Answer Upload File
Company Name
Company Address
Company Phone#
Name of Supervisor
Employed From Date
Employed to Date
Weekly Pay
Job Title and Describe Your Work
Reason for Leaving
References
Reference 1
Question Answer Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
Reference 2
Question Answer Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
Reference 3
Question Answer Upload File
If this Reference was a supervisor, list your last title with this employer
Reference Phone#
Reference Address
Reference Relationship
Reference Occupation
Reference Name
EEOC Supplemental Information
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.
Question Answer Upload File
How did you become aware of this Apprenticeship opportunity?
Number of years you have been employed in any occupation full-time to date (except military service)
Ethnicity
Number of Dependents
Statements of Understanding
You must answer ALL. If you need clarification on any item contact Local 91 JA Center
Question Answer Upload File
I am legally able to work in the United States
I understand that if accepted I will be subject to a drug test
I understand that any intentional false or misleading information will make me ineligible for the program
I understand that submitting an application is not a guarantee of employment or of acceptance into the program
I understand that my application is not complete until I have paid the Application fee and turned in all required documentation
I have read and meet the basic qualifications for entry into this program
I understand that it is my responsibility to keep the school informed of any changes in my address or phone number
Signature and Disclaimer
I have checked all the above to indicate my understanding, and state that, to the best of my knowledge, all information concerning my past 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).
Question Answer Upload File
Signature
Signature Date