Pre-Apprenticeship Application

Youth Guidance Pre-Apprenticeship Application
Personal Information
First Name:*
Middle Name:
Last Name:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Email:*
example@example.com
Date of Birth:

MonthDayYear
Date
What is your current age?*
What is your gender?*

MaleFemaleOther
National Origin:*

AsianBlackHispanicWhiteAmerican IndianOther
Do you have a state-issued Driver's License?*

YesNo
Do you have reliable transportation?*

YesNo
Emergency Contact Name:*
Emergency Contact Cell Phone Number:*
Emergency Contact Email:*
example@example.com
Do you have any physical issues or disabilities that would prevent you from using heavy machinery?*

YesNo
Number of Individuals in Household:*
Annual Household Income:*
Are you a United States citizen?*

YesNo
Education (please select highest grade completed):*

12345678910111213 (Postsecondary Level/College)14 (Postsecondary Level/College)15 (Postsecondary Level/College)16 (Postsecondary Level/College)
Diploma issued in the USA:*

H.S.GEDNo
Name of Last School Attended:*
Are you a Veteran?*

YesNo
Construction Training & Employment History
Are you currently employed?*

YesNo
Name of Previous or Current Employer:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name:

First NameLast Name
Telephone:
Please enter a valid phone number.
Indicate which trade(s) you are interested in:*

CarpentryElectricHVACIronworker/WeldingPipefitter/WeldingPlumbingSheetmetal Worker/WeldingNot Sure At This Time
Have you ever had Apprenticeship Training?*

YesNo
If Yes, what trade?
List all education and work experience you have related to the Construction Industry:*
Have you ever been convicted of a felony?*

YesNo
If yes, please explain:
I hereby swear and affirm that all of the above information is true and I understand that any false information given will result in immediate dismissal from the program. Parent or guardian signature if student is under age 16.
Signature:*

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Print Name:*
Today's Date:*

MonthDayYear
Date
Once the application has been processed, you will be contacted within 2-3 business days using the phone number provided. You'll be asked to sign all documents at the time of enrollment.
Should be Empty:

Youth Guidance Pre-Apprenticeship Application

Personal Information

Construction Training & Employment History