neca265

Application for Apprenticeship

You are applying for apprenticeship with

the Greater Nebraska Joint Electrical Apprenticeship and Training Committee.

I have read the guidelines for the position that I am applying for.

Please select the Apprenticeship you are applying for:

Inside Wireman Apprenticeship Construction Wireman / Construction Electrician

Email (If you do not have an email, just leave this field blank.)

Last Name

First Name

Middle

Address

City

State

Zip

Primary Phone#

Secondary Phone#

Social Security Number .......(omit dashes)

County

NAME CHANGE: Please provide the name that will appear on documents or transcripts that you submit, if it is different than your present name.

Former Last Name

Former First Name

Required Information Must Be Provided to Complete this Application

1. Check the Appropriate box(es) below the questions (A-F) to Indicate Your Means of Qualification 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 2,000 hours of electrical construction work experience.

C. I can produce undisputable documentation to verify that I have at least 4,000 hours of electrical construction work experience.

D. I am currently performing electrical construction work for an electrical contractor who became signatory to a union contract.

E. I am among the 50%, or more, who signed authorization cards while working for an electrical contractor during an organizing effort.

F. I am attempting to transfer into this program from another IBEW/NECA registered apprenticeship program for the same trade.

Education

2. Fill in the Circle to indicate the years of formal education you have completed.

3. Are you a High School Graduate?

Yes No

3a. If no do you have a GED?

Yes No

4. List College Degree(s) earned (Type in the boxes below):

Degree 1 (Please abbreviate to 10 characters max.) (AS: Associate of Science, BS: Bachelor of Science,...)

Major (Please limit your text to 24 characters.)

School (Please limit your text to 24 characters.)

Degree 2

Major

School

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

Yes No

5a. Indicate Math course(s) completed

Algebra 1

Yes No

Algebra 2

Yes No

Geometry

Yes No

Trigonometry

Yes No

Calculus

Yes No

NJATC Tech Math

Yes No

6. Have you completed any vocational/technical courses or training during or after high school?

Yes No

6a. List courses and/or training completed:

Background

7. Have you served in the US military?

Yes No

7a. If YES, how long in months?

7b. Which Branch?

7c. List which military training schools you have completed, if any:

7d. Did you get an honorable discharge?

Yes No

8. Have you ever been convicted of a felony?

Yes No

8a. If YES, explain the conviction:

9. Do you have electrical construction work experience?

Yes No

9a. If YES, how many months?

10. Do you have other construction work experience?

Yes No

11. Do you have any electrical/electronic work experience?

Yes No

12. Have you applied with this apprenticeship program before?

Yes No

12a. If YES, how many times?

13. Are you now, or have you ever been, a registered apprentice?

Yes No

13a. If YES, list apprenticeship sponsor or employer?

13b. If YES are you still an active apprentice in that program?

Yes No

14. Do you have a valid Driver's License?

Yes No

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

Yes No

15a. If YES, what class do you have?

A B Other

Interests and Abilities

16. List the main reason you are applying for this apprenticeship program. Please limit your text to 60 characters.

17. 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

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

Yes No

19. Are you able and willing to attend all related classroom training as required to complete your apprenticeship?

Yes No

20. Are you able to climb and work from ladders, scaffolds, poles and towers of various heights?

Yes No

21. Are you able to crawl and work in confined spaces such as attics, manholes and crawlspaces?

Yes No

22. Are you able to read, hear, understand, and follow instructions and warnings?

Yes No

Work History (Fill out the Work History Summary at the bottom of this form.)

23. Are you presently employed?

Yes No

23a. If YES, do you request that we NOT contact your present employer at this time?

Yes No

23b. Who is the current employer and contact?

24. Did you have any part-time or summer jobs while attending school?

Yes No

24a. What type of work?

25. Do you have the legal right to work in the United States of America?

Yes No

Statements of Understanding

You MUST Check Each Circle for Each of the Statements (A through I) Below to Indicate Your Knowledge and Understanding. NOTE: If You Need Clarification On Any Item Do NOT Hesitate to Ask Us.

Yes

A. I am aware that it is my responsibility to keep this program informed of any change in my address or phone number.

Yes

B. I have read and understand the basic qualifications for entry into the program.

Yes

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.

Yes

D. I understand it is my responsibility to see that all transcripts and other required documents are provided. If I fail to do so, my application will become null and void.

Yes

E. I understand that interviews for qualified applicants will be conducted in the order in which applications are completed.

Yes

F. I understand that any false information provided as part of my applications shall be just cause for denial of oral interview, or termination of my apprenticeship indenture agreement, should I be selected for the program.

Yes

G. I understand that an incomplete or unsigned application form will NOT be processed.

Yes

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.

Yes

I. I understand that only this ORIGINAL application form will be processed, and that Photocopies are NOT acceptable.

Yes

J. I am able and willing to follow instructions in order to safely complete any job task to the best of my ability.

Yes

K. I understand and agree that I must comply with all safety rules on the job and in any classroom.

Yes

L. I agree to submit and/or have other authorized persons submit all reports required by the JATC for the purpose of cataloging my personal work history, progress and related training activities and achievements.

Yes

M. I understand that I am NOT to solicit jobs directly with any electrical contractor.

Yes

N. I understand that the job may require working different shifts (day, evening, night) in order to complete work for customers, although most jobs require day shift hours.

Yes

O. I understand that my job performance will be evaluated periodically and reported to the JATC to assist in documenting my overall performance in the CW/CE Program. Such information is privately held by the JATC.

Yes

P. I understand that I may be required to complete courses or tests out of courses specified and/or approved by the JATC as a condition for advancement from one level to the next within the CW/CE Program.

Yes

Q. I understand that having documented 8,000 hours of work experience and having completed all required courses or having tested out of the courses, I may request to have my classification changed from Construction Wireman to Construction Electrician in an effort to seek Journeyman Wireman status.

Yes

R. I understand that as a Construction Electrician with 14,000 hours of documented work experience in electrical construction, I may seek to become a Journeyman Wireman by completing required training and testing.

Yes

S. I understand that all job (work) assignments for a Construction Wireman (CW) are made by the JATC and that all job referrals for a Construction Electrician are made by the IBEW Local Union 265.

I have checked all the above (Statements of Understanding) to 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. 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 (Apprenticeship Agreement). Type in your name in the box below as your signature to these statements.

I hereby apply for the position of Construction Wireman or Construction Electrician and agree if selected, I will abide by the sponsor’s Rules and Policies that pertain to the CW/CE program. Type in your name in the box below as your signature to these statements.

Type Full Name (This is your electronic signature.)

Apprenticeship Application 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, GENDER OR AGE - EXCEPT THAT THE APPLICANT MUST MEET THE MINIMUM AGE REQUIREMENT. THE JATC DOES NOT, AND WILL NOT, DISCRIMINATE BECAUSE OF THE DISABILITY OF SUCH INDIVIDUAL. WE RESPECTFULLY REQUEST THAT YOU ANSWER THESE QUESTIONS AS PART OF YOUR APPLICATION FOR APPRENTICESHIP.

---- PLEASE COMPLETE THE FOLLOWING ----

THE 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.

Race: (CHECK ONLY ONE)

American Indian or Alaskan Native Asian or Pacific Islander Black White

Ethnic Group: (CHECK ONLY ONE)

Hispanic Origin Not of Hispanic Origin

Gender

Male Female

Date of birth

How did you become aware of this apprenticeship opportunity?

If someone personally recommended this apprenticeship opportunity, please enter their name.

Work History Summary

(Enter an Employer Name and press the TAB key)

Employer #1

Address

City/State/Zip

From

To

Job Title

Work Performed

Reason for Leaving

Employer #2

Address

City/State/Zip

From

To

Job Title

Work Performed

Reason for Leaving

Employer #3

Address

City/State/Zip

From

To

Job Title

Work Performed

Reason for Leaving

Employer #4

Address

City/State/Zip

From

To

Job Title

Work Performed

Reason for Leaving

Do you have more than 4 employers on your resume?

Yes No

Please re-enter your SSN

Application for Apprenticeship

You are applying for apprenticeship with

the Greater Nebraska Joint Electrical Apprenticeship and Training Committee.

Required Information Must Be Provided to Complete this Application

1. Check the Appropriate box(es) below the questions (A-F) to Indicate Your Means of Qualification for Apprenticeship.

Education

4. List College Degree(s) earned (Type in the boxes below):

5a. Indicate Math course(s) completed

Background

Interests and Abilities

Work History (Fill out the Work History Summary at the bottom of this form.)

Statements of Understanding

Apprenticeship Application EEOC Supplemental Information

Work History Summary

(Enter an Employer Name and press the TAB key)

Privacy Policy: This policy covers how we use your personal information. We take your privacy seriously and

we will take all measures to protect your personal information. Any personal information received will only be

used to fill your order. We will not sell or redistribute your information to anyone.

Contact Phone Number: 402-397-5105

When you press the Submit button, you will be directed to a Credit Card checkout website.

You must pay the $20.00 Application Fee or your Application will not be processed.

Refund Policy: No Refunds

Please ignore that website because you will NOT be required to pay an Application Fee.

Be assured that your info has been sent to the Apprenticeship office.