Welcome to the APHCC of Alabama Plumbing Apprenticeship Program

Thank you for your interesting this program, and the journey you are about to undertake to advance your

knowledge and career in the plumbing industry.

In order to become a part of this program, follow these steps: Step 1 Complete the following Application for Admission. Step 2 Send the completed application to the APHCC of Alabama. You may send the application via mail or scan/e-mail to: Mail: APHCC of Alabama P.O. Box 36972 Birmingham, AL 35236 E-Mail: myalphcc@gmail.com Step 3 When you have received approval from the Education Committee, you will be instructed on method of payment for the $1500.00 per year tuition. P.S. DO NOT send your tuition payment with your application! According to U.S. Department of Labor standards, you will not be asked to submit your tuition payment until AFTER your application has been approved. Upon receipt of your tuition payment, you will be enrolled in Apprenticeship Program. The program directors will contact you with instructions on how to begin and use the online system.

GOOD LUCK!!

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! Associated*Plumbing*–*Heating*4*Cooling*Contractors*of*Alabama** APPLICATION*FOR*APPRENTICESHIP*______________________________________________________________________________!

Complete(this(application(and(mail(to:(APHCC(of(Alabama,(P.O.(Box(36972,(Birmingham,(AL(35236(PLEASE!PRINT! APPLICATION!DATE!_______________!

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Social!Security!Number_____!;!___!;!_______! Please!check!trade!of!interest:!Plumbing!___!

! ! Heating/Cooling!___!

!Full!Legal!Name:!

o!Mr.!o!Ms.!

o!Miss!o!Mrs.!

Last! First! Middle! Nickname!

Current!Address! Street!&!Apt!#! City! State! ZIP!

Permanent!

Address!

Street!&!Apt!#! City! State! ZIP!

Contact!Number!

(with!area!code)!

Home! Mobile! Work! Email!

Emergency!

Contact!

Name! Address! Relationship! Phone!Number!

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FEDERAL/STATE*REPORTING*REQUIREMENTS*The!following!information!is!only!

for!federal/state!reporting!

requirements.!The!information!you!

provide!below!will!not!in!any!way!

affect!the!admission!decision.!

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Sex:!Male!__!Female!__!

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American!Indian! __!

Black/Non;Hispanic! __!

White/Non;Hispanic! __!

Asian/Pacific!Islander! __!

Hispanic! __!

Other! __!

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CITIZENSHIP*U.S.!Citizen!__! !

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Permanent!resident!

(non;citizen)!__!

Country!of!citizenship!other!than!

U.S.!_______________!

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ENTRY*STATUS*!

High!School!student! __!

High!School!Graduate! __!

Earned!GED! __!

Some!college! __!

College!Graduate! __!

Other! __!

!MILITARY*STATUS*!

Veteran!of!Armed!Services! __!

Will!use!VA!benefits! __!

Active!Duty!Military! __!

!!!!!!!!!!!!!Rank!_____________!

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Retired!Military! __!

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EMPLOYMENT*STATUS*!

Currently!Employed! __!

Employed!in!the!trades! __!

Employed!full;time! __!

Employed!part;time! __!

Need!employment! __!

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If!employed,!please!give!the!following!information:!

Employer! ___________________________________!

Address!_____________________________________!

Phone! ______________________________________!

Supervisor!__________________________________!

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If!a!student,!please!give!the!following!information:!

High!School! !_________________________________!

Phone! _____________________________________!

Counselor! ___________________________________!

Teacher!_____________________________________!

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Employment*Information*for*APHCC*of*Alabama*Apprenticeship*Program**PLEASE*PRINT!!

Name!___________________________________!Social!Security!#!______!;!_____!;!_________!

!LIST*EMPLOYMENT*INFORMATION*BEGINNING*WITH*THE*MOST*RECENT*EMPLOYER*FIRST!

EMPLOYER* ADDRESS* JOB*TITLE* SUPERVISOR* PHONE*#* DATES*!

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From!_____/_____!

!To!_______/_____!

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From!_____/_____!

!To!_______/_____!

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To!_______/_____!

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From!_____/_____!!

To!_______/_____!

HOW*WOULD*AN*EMPLOYER*DESCRIBE*YOU*AS*AN*EMPLOYEE?*******HOW*WOULD*A*TEACHER*DESCRIBE*YOU*AS*A*STUDENT?*******!

PLEASE*READ*CAREFULLY*AND*SIGN**

I!certify!that!all!statement!contained!herein!are!correct!and!complete!and!I!further!agree!that!if!

any!of!the!information!I!am!providing!herein!shall!be!discovered!by!the!Associated!Plumbing,!

Heating!and!Cooling!Contractors!Apprenticeship!Program!to!be!false!or!incomplete,!then!the!

Apprenticeship!Committee!shall!have!the!right!to!suspend!or!discontinue!my!enrollment!in!the!

program.!

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Signature! ! Date!

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Educational*Information*for*APHCC*of*Alabama*Apprenticeship*Program*!

PLEASE*PRINT!!

Name!___________________________________!Social!Security!#!______!;!_____!;!_________!

!HIGH*SCHOOL*INFORMATION*FOR*APHCC*OF*AL*APPRENTICESHIP*

*HIGH*SCHOOL*LAST*

ATTENDED***

CITY,*STATE* DATES*OF*ATTENDANCE**

FROM!________/_______!

TO!__________/________*

DID*YOU*EARN*YOUR*DIPLOMA?**

o!YES!!!!!!!!o!NO*DATE*OF*HIGH*SCHOOL*GRADUATION*(OR*EXPECTED):* MONTH*_____________________*

YEAR_____________*IF*YOU*DID*NOT*EARN*A*HIGH*SCHOOL*DIPLOMA,*PLEASE*PROVIDE*GED*INFORMATION*HERE.*

HAVE*YOU*EARNED*A*GED?**o!YES!!!!!!!!!!!!!o!NO*

WHEN*AND*WHERE*DID*YOU*COMPLETE*YOU*GED?*YEAR________*LOCATION*_________________**

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COLLEGE*IFORMATION*FOR*APHCC*OF*AL*APPRENTICESHIP**

LIST*ALL*COLLEGES*ATTENDED*(MOST*RECENT*FIRST)*INSTITUTION* CITY,*STATE* DATES*OF*ATTENDANCE* DID*YOU*GRADUATE?*

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* FROM!________/_______!

TO!__________/________!

*o!YES!!!!!!!!!!!!!!!!!o!NO!

* * FROM!________/_______!

TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*

* * FROM!________/_______!

TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*

* * FROM!________/_______!

TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*

*IF*YOU*GRADUATED,*TYPE*OF*DEGREE*___________________________*GRADUATION*DATE*_________________*PLEASE*PROVIDE*ANY*FORMER*NAMES*YOU*MAY*HAVE*USED*WHILE*ATTENDING*SCHOOL:***

PLEASE*READ*CAREFULLY*AND*SIGN**

I!certify!that!I!comply!with!the!provisions!of!the!United!States!Military!Selective!Service!Act!(50!U.S.C!

App!453)!by!having!registered!with!the!Selective!Service!Board!or!that!I!am!not!yet!18!years!of!age!and!I!

will!register!when!required!or!that!I!am!not!required!by!law!to!register.!(This!certification!is!required!by!

the!State!of!Alabama!Legislative!Act!91;584.)!

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I,!the!undersigned!applicant!for!admission,!understand!that!withholding!information!requested!in!this!

application,!or!giving!false!information,!will!make!me!ineligible!for!the!admission!to!the!APHCC!of!

Alabama!Apprenticeship!Program.!I!certify!that!all!statements!contained!herein!are!correct!and!

complete!and!I!further!agree!that!if!any!of!the!information!I!am!providing!herein!shall!be!discovered!by!

the!APHCC!of!Alabama!Apprenticeship!Program!to!be!false!or!incomplete,!then!the!Apprenticeship!

Committee!shall!have!the!right!to!suspend!or!discontinue!my!enrollment!in!the!program.!

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Signature! ! Date!

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!Career*Information*for*the*APHCC*of*Alabama*Apprenticeship*Program*

*WHAT*IS*YOUR*PRIMARY*REASON*FOR*APPLYING*TO*THE*APPRENTICESHIP*PROGRAM?*(CHECK*ONE)**o!LEARN*SKILLS* o!EARN*CERTIFICATE*TO*

ADVANCE*IN*A*JOB!o!EARN*DEPARTMENT*OF*LABOR*CERTIFICATION!

o!WORK*WHILE*EARNING*CERTIFICATION!

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HOW*WOULD*YOU*RATE*YOURSELF*ON*THE*FOLLOWING:**Math!Ability! o!!high! o!!average! o!!low!

Reading!Ability! o!!high! o!!average! o!!low!

Problem!Solving! o!!high! o!!average! o!!low!

Critical!Thinking! o!!high! o!!average! o!!low!

Team!Work! o!!high! o!!average! o!!low!

Mechanical!Ability! o!!high! o!!average! o!!low!

Manual!Skills! o!!high! o!!average! o!!low!

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HOW*WOULD*YOU*RATE*YOUR*INTEREST*IN*THE*FOLLOWING:**Operating!Power!Tools! o!!high! o!!average! o!!low!

Drawing!Blueprints! o!!high! o!!average! o!!low!

Repairing!Equipment! o!!high! o!!average! o!!low!

Working!on!Motors! o!!high! o!!average! o!!low!

Making!Simple!Electrical!Repairs! o!!high! o!!average! o!!low!

Making!Simple!Plumbing!Repairs! o!!high! o!!average! o!!low!

Repairing!Furniture! o!!high! o!!average! o!!low!

Using!Carpentry!Tools! o!!high! o!!average! o!!low!

Building!a!Bench! o!!high! o!!average! o!!low!

Playing!with!LEGOS! o!!high! o!!average! o!!low!

Refinishing!Furniture! o!!high! o!!average! o!!low!

Painting!a!Room! o!!high! o!!average! o!!low!

Working!Outdoors! o!!high! o!!average! o!!low!

Fishing! o!!high! o!!average! o!!low!

Hunting!Game! o!!high! o!!average! o!!low!

Solving!Math!Problems! o!!high! o!!average! o!!low!

Solving!Physics!Problems! o!!high! o!!average! o!!low!

Playing!Team!Sports! o!!high! o!!average! o!!low!

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PLEASE*READ*CAREFULLY*AND*SIGN**I!certify!that!all!statements!contained!herein!are!correct!and!complete.!

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Signature! ! Date!

!Mail(the(completed(application(to:(APHCC(of(Alabama,(P.O.(Box(36972,(Birmingham,(AL(35236(

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Employer*Acceptance*Agreement**The!foregoing!undersigned!employer!hereby!subscribes!to!the!provisions!of!the!Apprenticeship!

Standards!formulated!and!registered!by!the!Associated!Plumbing!–!Heating!–!Cooling!

Contractors!of!Alabama.!__________________________!!(name!of!employing!company)!agrees!

to!carry!out!the!intent!and!purpose!of!said!Standards!and!abide!by!the!rules!and!decisions!of!

the!APHCC!of!Alabama!established!under!these!Apprentice!Standards!and!do!hereby!request!

certification!to!train!apprentice!under!the!provisions!of!these!Standards,!with!all!attendant!

rights!and!benefits!thereof,!until!cancelled!voluntarily!or!revoked!by!the!sponsor!or!Registration!

Agency.!On;the;job,!the!apprentice!is!hereby!guaranteed!assignment!to!a!skilled!and!

competent!journey!worker!and!is!guaranteed!that!the!work!assigned!to!the!apprentice!will!be!

rotated!so!as!to!ensure!training!in!all!phases!of!work.!The!employer!further!agrees!to!accept!for!

the!employment!apprentices!who!are!recommended!by!him!or!her!and!fulfill!the!requirement!

of!apprenticeship!to!the!extent!appropriate!employment!opportunities!are!available.!

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! Signed:!________________________________! Date:!____________!

! Title:!__________________________________!

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Name!of!Company:!______________________________________________________________!

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Address:!_______________________________________________________________________!

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City,!State!ZIP:!__________________________________________________________________!

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Phone,!FAX,!Email:!_______________________________________________________________!

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Disposition:!

! Original:!APHCC!of!Alabama!

! Copies:!Employer,!Registration!Agency! !