ALASKA JOINT ELECTRICAL APPRENTICESHIP AND TRAINING TRUST

DEBORAH KELLYStatewide Training Director

Tom Cashen Training Center5800 B Street

Anchorage, AK 99518Tel: (907) 337-9508

Fax: (907) 337-9500

TIM BRANNANTraining CoordinatorKornfeind Training Center4782 Dale RoadFairbanks, AK 99709Tel: (907) 479-4449Fax: (907) 479-0425

COVID-19 Notice: If you are experiencing difficulty in submitting a complete application packet due to circumstances cause by the current COVID-19 outbreak, please contact the apprenticeship school for assistance. To submit your application, please visit alaskaelectricalapprenticeship.org and click “How to Apply” for instructions.

Qualification for Apprenticeship An individual who can show that they meet the conditions listed below will be scheduled for an interview. If interviewed, the applicant will be listed among those applicants qualified for selection, according to interview score, for two years following the interview date.

Prior to being indentured applicants will be required to submit to a drug test and obtain negative results, and may be required to provide results of a physical examination.

You must meet all of the following requirements for your application to be accepted:

• Be a minimum of 18 years of age.

• Possess a valid Alaska drivers’ license.

• Provide a copy of your high school diploma or state issued GED certificate.

• Show evidence of successful completion of one of the following: one full year of highschool algebra with a final grade of ‘C’ or higher, one post high school algebra coursewith a passing grade, a certificate showing completion of the NJATC math course, orthe State of Alaska WorkKeys math test with a ‘6’ or higher.

• Provide your transcripts for high school and post high school education and training.GED records must be submitted if applicable.

• Pay a $25.00 application fee to the AJEATT.

If any of the following apply, you may qualify for interview through alternate means. Please contact the AJEATT office if:

• You are a United States Veteran who was discharged within the last 5 years

• You are an active member of the United States military

• You have at least 2,000 hours of documented experience in the trade for which youare applying

The AJEATT will not discriminate against apprenticeship applicants or apprentices based on race, color,religion, national origin, sex (including pregnancy and gender identity), sexual orientation, genetic

information, or because they are an individual with a disability or a person 40 years old or older. The AJEATT will take affirmative action to provide equal opportunity in apprenticeship and will operate the apprenticeship

program as required under Title 29 of the Code of Federal Regulations, part 30.

■ 59472 SPONSOR

PROGRAM NUMBER OR I.D. CODE

APPRENTICESHIP APPLICATION

FORM FOR: (Darken Only One) 0 Wireman O Residential

0 Lineman O Telecommunications

APPLICANT APPLICATION NO.

■ I I I I I I I

ALL THE ABOVE (TOP SECTION) IS TO BE COMPLETED BEFORE GIVING THIS FORM TO THE APPLICANT THE REMAINDER OF THIS FORM IS TO BE COMPLETED ENTIRELY BY THE APPLICANT

Print Letten (IN CAPS) and Num•er Inside the Bax. Use Black ar Blue Ink. Darken Appnprlate Oval(s) to Indicate Your Response , Where Required.

NAME

Lost

First

Address

City

Dote of This Application

Middle

State Zip

Phone Address ___________________ _ Soc:iol Security Number

NAME CNANGE1 Please provide the name that will appear on docu111enh or transcripts that you sullmit, If It is differ-• th■n your present name.

Lost

Required Information Must Be Provided to C■mplete this Application.

l. Darken the Appropriate Ovol(s) (A-F) to Indicate Your Means of Qualification for Apprenticeship. Completely fill in the marked Ovol(s).

O A. I believe I con meet all minimum qualifications for apprenticeship.

OB. I con produce undisputoble documentation to verify that I hove at least 4,000 hours of elec:tricol construc:tion work experience.

O C. I om currently performing electrical construc:tion work for on electrical contractor who become signatory to a union controc:t. The name of the contractor is:

O D. I om among the 50%, or more, who signed authorization cords while working for on electrical contractor during on organizing effort.

OE.

The name of the controc:tor is:

I om attempting to qualify for, ond participate in, the School-to-Registered-Apprenticeship Program.

OF. I om attempting lo transfer into this program from another IBEW /NECA registered apprenticeship program for the same trade.

EDUCATION

2. Fill in the Oval to indicate the years of formal education you have completed: <10 10 11 12 13 14 15 16 17 18 >18 0 0 0 0 0 0 0 0 0 0 0

3. Are you a High School Graduate?

If NO, do you have a GED?

YesO

YesO

No 0

No 0

4. List College Degree(s) earned (PRINT within the boxes below): Degree 1 (Highest Degree Earned)

O10r

C 00

■ Apprenticeship Application Revi5ed 06/07/2001

First

Degree 2 (Second Highest Degree Earned, if any)

Major

School

5. Have you received one (1) full credit for Algebra, or some higher moth course, from on accredited school?

5o. Indicate Math course(s) completed: 0 Algebra I O Algebra II

0 Geometry

0 Calculus

0 Trigonometry

0 NJATC Tech Math

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

60. List courses and/ or training completed:

YesO

YesO

7. Hove you served in the US military?

7a. If YES, how Long?

YesO

In Months

7b. Which Branch? Army O Navy O Air Force O Marines 0

Coast Guard O Military Reserve 0

No 0

No 0

No 0

7c. List which military training schools you completed, if any. _____ _

8. Hove you ever been convicted of a felony? (Conviction will not automatically disqualify you.)

YesO No 0

If YES, explain the conviction: _________________ _

S258K

■

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Name:_____________________________ Classification:______________

Work History Please list all employers beginning with your present or most recent employer

Job Title: Employer: Employers Address: City: State: Zip: Date employment started: Date employment terminated: Supervisor’s Name: Supervisor’s Contact Phone:

Please describe work performed and indicate reason for leaving:

Job Title: Employer: Employers Address: City: State: Zip: Date employment started: Date employment terminated: Supervisor’s Name: Supervisor’s Contact Phone:

Please describe work performed and indicate reason for leaving:

Job Title: Employer: Employers Address: City: State: Zip: Date employment started: Date employment terminated: Supervisor’s Name: Supervisor’s Contact Phone:

Please describe work performed and indicate reason for leaving:

Apprenticeship Application EEOC Supplemental Information Form THE ALASKA JOINT ELECTRICAL APPRENTICESHIP AND TRAINING TRUST 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 (INCLUDING PREGNANCY AND GENDER IDENTITY), SEXUAL ORIENTATION, GENETIC INFORMATION, OR BECAUSE THEY ARE AN INDIVIDUAL WITH A DISABILITY OR A PERSON 40 YEARS OLD OR OLDER. WE RESPECTFULLY REQUEST THAT YOU RETURN THIS FORM ALONG WITH YOUR COMPLETED APPLICATION FORM 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.

Social Security Number:

Date of Birth:

Male Sex: Female

Race: Ethnic Group: CHECK ONLY ONE American Indian or Alaskan Native Hispanic Origin Asian or Pacific Islander Not of Hispanic Origin Black White

How did you become aware of this apprenticeship opportunity? Word-of-Mouth Outreach Organization TV Radio Career Day Newspaper (name of paper) Posted Announcement Other Guidance Counselor

This form will not become part of your personal file. It will be maintained in a separate file, used only for EEOC reporting purposes.

YOUR APPLICATION NO. IS

Training/Experience Survey THE PURPOSE OF THIS SURVEY IS TO HELP THE AJEATT TO RECRUIT AND TRAIN MORE EFFECTIVELY. THE INFORMATION PROVIDED ON THIS PAGE ONLY MAY BE SHARED WITH ALASKA WORKS PARTNERSHIP, A TRAINING PARTNER OF THE AJEATT. THANK YOU FOR YOUR PARTICIPATION.

Have you participated in any of the following training programs? Construction Academy (Alaska Works) AVTEC Electrical or IT Helmets To Hardhats (Alaska Works) Lineman School Women in the Trades (Alaska Works) Alaska Military Youth Academy King Career Center Construction Job Corps

Electricity or Telecommunications Other (Please List)

Are you a Veteran or Active Duty Service Member? I have not served in the Military Veteran Active Duty Reserves

If you are a Veteran or Active Duty Service Member, have you registered with Helmets To Hardhats? Yes No

Do you have previous experience in construction? Yes No

What kind of Drivers License do you currently possess? Drivers License Class A CDL CDL Permit Class B CDL

What is the highest level of formal education you have completed? GED Some College High School Diploma Associate Degree or Higher Technical Degree or Certificate Other _______________________________________

In what part of Alaska do you currently reside? Anchorage Area Fairbanks Area Mat-Su Valley Kenai Peninsula Juneau Area Kodiak Island Ketchikan Area Rural (Please Specify) __________________________________________________________________

This form will not become part of your personal file. It will be maintained in a separate file, used only for recruitment purposes. By signing below you give the AJEATT permission to share the information ON THIS PAGE ONLY with our training partners.

Signed____________________________________ Printed Name___________________________________