IWLU440 Application Form

Ironworkers 440

Apprenticeship Application
Iron Workers Local 440 JAC is an Equal Opportunity Apprenticeship and Training Program and does not discriminate in selection or the terms of apprenticeship training on the basis of race, color, religion, creed, national origin, sex, ancestry, disability or any other basis prohibited by law. Information obtained on this application is not intended to secure information to be used for determining admission nor will any information provided be used for any purpose prohibited by law.
We are required, by the United States Department of Labor, Office of Federal Contract Compliance Programs, to maintain applicant data by race, gender, veteran status, etc. It would be greatly appreciated if you would voluntarily provide us with the following information. This information will be maintained in a separate, confidential file. Please select all that apply to you.*

US CitizenResident AlienMaleFemaleVeteranBlackHispanicAsianNative AmericanCaucasian
How did you learn of this position?*
APPLICATION FOR APPRENTICESHIP
Name*

First NameMiddle NameLast Name
Social Security Number*
Are you 18 years or older?*

YesNo
Address*

Street Address

County

CityState / Province

Postal / Zip Code
Military Experience?*

YESNO
Which Branch?
Number of Years in Service
Primary Phone*
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
E mail Address*
example@example.com
Applicant's School Experience Record
High School*

DiplomaGED
Name of School*
City and State*
Additional Schooling
Number of years
Name of School
City and State
Additional Schooling
Number of years
Name of School
City and State
Applicant's Work Experience Record List the names and addresses of each employer for whom you have worked, including military service. List present employer first. Employer Name and Address Dates of Employment
Applicant's Work Experience Record

List the names and addresses of each employer for whom you have worked, including military service. List present employer first.

Rows	Employer Name & Address	Nature of work done	Dates of Employment	Number of months
1
2
3
4
5
6
7
8
9
10
11

List any current certifications (First Aid, OSHA, AWS)
Please Supply Copies of: Diploma/GED, Birth Certificate, DD214 (if former military), Current Certifications, Driver's License, Social Security Card or other documents. *

Cancelof
All candidates, if selected, must provide proof of ability to work the United States.
Statements of Understanding
I am prepared to work for more than one employer during the period of my apprenticeship.*

YesNo
I am prepared to attend school whenever requested by the Apprenticeship Coordinator or face cancellation of my apprenticeship.*

YesNo
I am aware that it is my responsibility to keep the Apprenticeship Coordinator aware of any change in my address or phone number.*

YesNo
I am prepared to travel out of town for work as may be required.*

YesNo
I understand that if selected, I will be required to complete the selection process by qualifying on any examination, including a physical examination or drug testing either before or after signing an indenture.*

YesNo
I understand that any intentional false statement or information that I have provided on this application or on other documents shall be cause for denial of an oral interview or termination of indenture, should I be selected for the program.*

YesNo
Date*

MonthDayYear
Date
Signature*
Should be Empty:

Ironworkers 440

APPLICATION FOR APPRENTICESHIP

Applicant's School Experience Record

Additional Schooling

Additional Schooling

Applicant's Work Experience Record

All candidates, if selected, must provide proof of ability to work the United States.

Statements of Understanding