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Application Type	Apprentice WiremanSound ApprenticeTransportation Systems ApprenticeResidential Apprentice
Last 4 Digits of SSN		Address
Last Name
First Name		City
Middle Initial		State/Zip Code
Date Of Birth		Email Address
		Verify Email

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Home Phone Cell Phone Cell Carrier Alltel At&t, Consumer Cellular, Or Pure Talkusa Boost Mobile C Spire Cricket Google Fi (Project Fi) Metro Pcs Republic Wireless Simple Mobile Sprint Or Twigby Straighttalk T-Mobile, Mint Mobile, Or Ting (Gsm Devices) Ting (Cdma Devices) Tracfone Or Simple Mobile U.s. Cellular Verizon, Xfinity Mobile, Spectrum Mobile, Page Plus, Great Call, Or Visible Virgin Mobile Unsupported Carrier

By providing your cell phone carrier, you are opting to receive text message notifications from the ETI. If you do not wish to receive updates via text message, you should not provide your cell phone carrier. If your cell carrier is not listed in the dropdown list, text notifications will not be available to you at this time. Feel free to input your cell carrier’s name in the "unsupported carrier" field and we will notify you if this feature becomes available.

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Highest Year of Education Completed	High School(s)
12th Grade (or GED Certificate)
1 Year of College
2 Years of College
A.A. Degree	College(s) or Vocational School(s)
3 Years of College
4 or more Years of College
B.A., B.S. or Higher Degree

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Yes No Do you have any electrical/electronic experience? Yes No Have you applied with this apprenticeship program before? If YES, how many times? Yes No Have you participated in an apprenticeship of any kind? If YES, in what? Yes No Do you have a Government Issued Photo ID?

Yes No Did you complete any school-to-career program? If YES, what Program? Yes No Have you served in the US military? If YES, please enter dates. Entry Date Discharged Which Branch? List military training (MOS) you completed, if any.

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List the reason(s) why you are applying for this apprenticeship program:
Yes	No	Are you physically and mentally able to safely perform or learn to safely perform the work of this trade, either with or without reasonable accommodations?
Yes	No	Are you able to get to and from work at various job sites anywhere within the geographical area this apprenticeship program covers?
Yes	No	Are you able and willing to attend all related classroom training required?
Yes	No	Are you able to climb and work from ladders, scaffolds, poles or towers of various heights with or without reasonable accommodations?
Yes	No	Can you crawl and work in confined spaces such as attics, manholes and crawl spaces with or without reasonable accommodations?
Yes	No	Are you available to work full-time during any shift?
Yes	No	Are you able to hear and understand verbal instructions and warnings given in English?

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1. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

2. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

3. Company Name		Name of Supervisor
Address		Employed From (mm/yyyy)
		Employed To (mm/yyyy)
Phone Number		Weekly Pay
State your Job Title and Describe your Work		Reason for Leaving

Number of Years You Have Been Employed in any Occupation Full-Time to Date (Except for Military Service)	How did you become aware of this apprenticeship opportunity?
None	Career Day	PV Jobs
Less Than 1 Year	Career Technical School	Trades Person
Year 1 But Less Than 2	Community College	Website
2 But Less Than 3 Years	Faith-Based Organization	We Build
3 But Less Than 4 Years	Helmets to Hardhats	WINTER
4 But Less Than 5 Years	Media Radio, TV, Newspaper	Work Force Group
5 Years or More	Outreach Organization	Other

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The ETI will not discriminate against apprenticeship applicants or apprentices based on race, religious creed (including religious dress and grooming), color, national origin, ancestry, physical disability, mental disability (including cognitive disability), medical condition, genetic information, marital status, sex (including pregnancy, childbirth, and medical conditions related to pregnancy, childbirth, or breast feeding), sexual orientation, sex stereotype, gender, gender identity, gender expression, age 40 or older, and military and veteran status. The ETI will take affirmative action to provide equal opportunity in apprenticeship and will operate, conduct, and administer this apprenticeship program as required under Title 29 of the Code of Federal Regulations, part 30, and the equal opportunity regulations of the State of California.

It is against the law for a sponsor of an apprenticeship program registered for Federal purposes to discriminate or retaliate against, or harass, an apprenticeship applicant or apprentice based on race, color, religion, national origin, sex, sexual orientation, age (40 years or older), genetic information, or disability. The sponsor must ensure equal opportunity with regard to all terms, conditions, and privileges associated with apprenticeship.

FILING A DISCRIMINATION COMPLAINT: If you think you have been subjected to such discrimination, harassment, or retaliation, you may file a complaint: a) within 300 days from the date of the alleged discrimination, harassment, retaliation, or failure to follow the equal opportunity standards with the U.S. Department of Labor, Office of Apprenticeship, 200 Constitution Avenue, NW, Washington, DC 20210, Attn: Apprenticeship EEO Complaints, Jose Velazquez, (202) 693-2909, ApprenticeshipEEOcomplaints@dol.gov; or b) within 180 days from the date of the alleged discrimination, harassment, retaliation, or failure to follow the equal opportunity standards with the State of California, Division of Apprenticeship Standards, Administrator of Apprenticeship, Department of Industrial Relations, 1515 Clay Street, Oakland, CA 94612. You may also be able to file complaints directly with the U.S. Equal Employment Opportunity Commission (EEOC) or the California Department of Fair Employment and Housing (DFEH) within the time periods set by those agencies. Their contact information is as follows: c) EEOC: 1-800-669-4000 (toll-free) or 1-800-669-6820 (toll-free TTY number for individuals with hearing impairments). EEOC field office information is available at www.eeoc.gov or in most telephone directories in the U.S. Government or Federal Government section. Additional information about EEOC, including information about charge filing, is available at www.eeoc.gov; and d) DFEH: (800)884-1684; TTY (800)700-2320; videophone for the hearing impaired (916)226-5285; email contact.center@dfeh.ca.gov, or www.dfeh.ca.gov.

Each complaint filed must be made in writing and include the following information:
1.	Complainant’s name, address and telephone number, or other means for contacting the complainant;
2.	The identity of the respondent (i.e. the name, address, and telephone number of the individual or entity that the complainant alleges is responsible for the discrimination);
3.	A short description of the events that the complainant believes were discriminatory, harassing, or retaliatory, including, but not limited to, when the events took place, what occurred, and why the complainant believes the actions were discriminatory, harassing, or retaliatory (for example, because of his/her race, color, religion, sex, sexual orientation, national origin, age (40 or older), genetic information, or disability); and
4.	The complainant’s signature or the signature of the complainant’s authorized representative.

The information voluntarily provided below is simply for equal employment opportunity purposes. This information will assist us in our efforts to provide accurate information in compliance with federal, state, and local Equal Employment Opportunity regulations and requirements.

Ethnic or Race Derivation (Check Only One)

Declined To AnswerAsian - ChineseIndian Or Alaska NativeAsian - PakistaniNative Hawaiian Hawaiian HispanicAsian - IndianAsian - CambodianAsian - Sri LankanNative Hawaiian Samoan Black/African AmericanAsian - KoreanAsian - HmongAsian - TaiwaneseNative Hawaiian Tongan Asian - FilipinoAsian - ThaiAsian - LaotianNative Hawaiian FijianWhite (Not Of Hispanic Origin) Asian - JapaneseAsian - VietnameseAsian - MalaysianNative Hawaiian GuamanianOther

Gender	Number of Dependents
Female Male	None	Four
	One	Five
	Two	Six or More
	Three

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Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Why are you being asked to complete this form? Because we are a sponsor of a registered apprenticeship program and participate in the National Registered Apprenticeship System that is regulated by the U.S. Department of Labor, we must reach out to, enroll, and provide equal opportunity in apprenticeship to qualified people with disabilities.[1] To help us learn how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for apprenticeship, any answer you give will be kept private and will not be used against you in any way. If you already are an apprentice within our registered apprenticeship program, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our apprentices at the time of enrollment, and then remind them yearly, that they may update their information. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obsessive compulsive disorder, impairments requiring the use of a wheelchair, intellectual disability (previously called mental retardation). __________________ [1] Part 30 – Equal Employment Opportunity in Apprenticeship. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Apprenticeship website at https://www.doleta.gov/OA/eeo/.

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You must check ALL the Boxes. If you need clarification on any item contact ETI.
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 this program.
C.	I have been given specific instructions as to what is required of me to complete this application and to become qualified for oral interview.
D.	I understand that I must furnish documentation to provide evidence that I do meet the qualifications required for entry into the pool of eligible candidates for this apprenticeship.
E.	I understand that it is my responsibility to see that all OFFICIAL transcripts and other required documents are provided in a timely manner in order to complete my application.
F.	I understand that if I fail to submit ALL of the required information within the specified time frame, my application may be considered incomplete.
G.	I understand that I cannot qualify for interview until I have met the minimum basic qualifications and have provided the necessary transcripts and documents as required.
H.	I hereby acknowledge that I bear the sole responsibility for completing my application following the instructions provided.
I.	I understand that interviews for qualified applicants will be scheduled in the order in which the applications are completed.
J.	I understand that any intentional false statement or information that I provide on this application form or on other documents shall be cause for denial of oral interview or termination of indenture, should I be selected for the program.
K.	I understand that an incomplete or unsigned application form will NOT be processed.
L.	I understand that if selected, I will be required to complete the selection process by qualifying on any examination, including a physical examination or drug testing, if required by the sponsor; either before or after signing an indenture.
M.	I have the legal right to work in the United States of America.

I have checked all the above (A thru M) to indicate my understanding, and state that, to the best of my knowledge, 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 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).

Please provide your firstname and lastname between two forward slash "/" symbols in order to indicate your agreement to these terms. (Examples: /firstname lastname/, /John Doe/)

Digital Signature

Date of Digital Signature