JOINT APPRENTICESHIP & TRAINING PROGRAM
Application for Apprenticeship
 
*NOTE - all dates must be entered in the 00/00/00 format.
 
Name:
Social Security Number:
 
Address:
(County) (City) (State) (Zip)
Phone:
U.S. Citizen:
Have you registered for Selective Service?
Date of Birth: Place of Birth:
Gender: Male Female
Race:
Non Hispanic White Non Hispanic Black Hispanic
Asian or Pacific Islander American Indian or Alaskan Native Other
 
 
Education
High School :
Grade Completed:
GED:
Vocational/Trade School:
Attended: Years Attended:
Course of Study:
College:
Years Attended:
Major Course of Study:
Certifications: If you hold any certifications, please list them below
 
 
Work History
Have you ever been terminated or laid off as a result of a company closure?
If Yes:  
Please list the company and location:
Approximate date of layoff:
Are you currently employed?
If Yes:  
Employer:
Start Date:
Job Title:
Hours Per Week:
Job Duties:
Work History (list most recent first)  
Employer:
Start Date:
Job Title:
End Date:
 
Hours Per Week:
Job Duties:
Reason for Leaving:
Employer:
Start Date:
Job Title:
End Date:
 
Hours Per Week:
Job Duties :
Reason for Leaving:
Employer:
Start Date:
Job Title:
End Date:
 
Hours Per Week:
Job Duties :
Reason for Leaving:
Are you authorized to work in this country?
Veteran?
If Yes:  
Branch of Service:
Years Served:
Special Training:
Type of Discharge:
Are you willing to attend, on your own time, training classes, and any meetings scheduled by the Committee?
Do you realize there is no guarantee of continuous or stable employment?
Have you ever applied for any apprentice training?
When: Where: Which Trade:
Does it bother you to work in high places or off scaffolds?
Does it bother you to work in confined spaces?
Will it bother you to work with hazardous materials after adequate training?
Reason for wanting to be an Asbestos Worker:
How did you find out about the availability of our apprenticeship?  
 
 
 
Work Experience References
1.
Name:
Address:
Phone:
2.
Name:
Address:
Phone:
3.
Name:
Address:
Phone:
 
 
Character References
1.
Name:
Address:
Phone:
2.
Name:
Address:
Phone:
3.
Name:
Address:
Phone:
 

You are required to mail in copies of...

Birth Certificate
Drivers License
Social Security Card

Please send to the address listed below

3263 Schoolhouse Road,
Middletown, PA 17057

  
 

 
 
 
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