NAME CHANGE: Please provide the name that will appear on documents or
transcripts that you submit, if it is different than your present name.
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
18. Are you able to get to and from work at job sites anywhere within
the geographical area that this apprenticeship program covers?
19. Are you able and willing to attend all related classroom training
as required to complete your apprenticeship?
20. Are you able to climb and work from ladders, scaffolds, poles and
towers of various heights?
21. Are you able to crawl and work in confined spaces such as attics,
manholes and crawlspaces?
22. Are you able to read, hear, understand, and follow instructions and
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.
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
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.
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.
E. I understand that interviews for qualified applicants will be conducted
in the order in which applications are completed.
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.
G. I understand that an incomplete or unsigned application form will NOT
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.
I. I understand that only this ORIGINAL application form will be processed,
and that Photocopies are NOT acceptable.
J. I am able and willing to follow instructions in order to safely complete
any job task to the best of my ability.
K. I understand and agree that I must comply with all safety rules on
the job and in any classroom.
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.
M. I understand that I am NOT to solicit jobs directly with any electrical
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.
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.
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.
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.
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.
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.
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
---- 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.