Applicant Information

Application Type
Last 4 Digits of SSN Address
Last Name
First Name City
Middle Initial State/Zip Code
Home Phone Email Address
Cell Phone Verify Email

Highest Year of Education Completed High School(s)
College(s) or Vocational School(s)

Have you ever been convicted of a felony? Did you complete any school-to-career program?
If YES, explain the conviction. (Conviction will not automatically disqualify you.) If YES, what Program?
Have you served in the US military?
Do you have any electrical/electronic experience? If YES, please enter dates.
Have you applied with this apprenticeship program before? Entry Date
If YES, how many times? Discharged
Have you participated in an apprenticeship of any kind? Which Branch?
If YES, in what?
List military training (MOS) you completed, if any.
Do you have a valid Driver's License?  
Interest & Ability

List the reason(s) why you are applying for this apprenticeship program:
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?
Are you able to get to and from work at various job sites anywhere within the geographical area this apprenticeship program covers?
Are you able and willing to attend all related classroom training required?
Are you able to climb and work from ladders, scaffolds, poles or towers of various heights?
Can you crawl and work in confined spaces such as attics, manholes and crawl spaces?
Are you available to work full-time during any shift?
Are you able to hear and understand verbal instructions and warnings given in English?
Employment History

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
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 requirments.

Ethnicity Number of Dependents Number of Years You Have Been Employed
in any Occupation Full-Time to Date
(Except for Military Service)
Date Of Birth How did you become aware of this apprenticeship opportunity?
Statements Of Understanding

You must check ALL the Boxes. If you need clarification on any item contact ETI.

I am aware that it is my responsibility to keep this program informed of any change in my address or phone number.
I have read and understand the basic qualifications for entry into this program.
I have been given specific instructions as to what is required of me to complete this application and to become qualified for oral interview.
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.
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.
I understand that if I fail to submit ALL of the required information within the specified time frame, my application may be considered incomplete.
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.
I hereby acknowledge that I bear the sole responsibility for completing my application following the instructions provided.
I understand that interviews for qualified applicants will be conducted in the order in which the applications are completed.
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.
I understand that an incomplete or unsigned application form will NOT be processed.
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.
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 diclose 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 Induture (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


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Application Entry

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