Adult Apprenticeship Application

Adult Apprenticeship Application
QUALIFICATIONS FOR THE BUILD MISSISSIPPI APPRENTICESHIP PROGRAM
Name*

First NameLast Name
Build Mississippi does not provide employment; however, enrollment in Adult Craft Training programs could provide opportunities for employment with our Training Partners. *Employment is not a requirement to enroll in the ACT programs.*

I understand
Be able to provide a state or federal issued photo ID.*

I understand
Be physically capable of performing the essential functions of the apprenticeship program, without posing a direct threat to the health and safety of yourself or others.*

I understand
Be physically capable of passing a third party administered drug test.*

I understand
Have a dependable means of transportation to the employer's place of business and/or jobsite and to the place where classroom job-related instruction is conducted.*

I understand
Applicants must provide proof of previous work experience or vocational training in order to receive credit for their experience or training.*

I understand
For registration with MS Department of Labor Apprenticeship you are required to be at least 18 years old and provide proof of age such as a driver's license or state issued ID. You will also be required to provide a copy of your high school diploma, transcript showing completion or a copy of GED. This is not a requirement for Build Mississippi's apprenticeship program unless you intend to register with DOL.*

I understand
Personal Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Birthdate*

MonthDayYear
Date
Emergency Contact Information
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Additional Questions
Do you have Military Experience?*

YesNo
If yes, will you be applying for VA Benefits?*

YesNo
Do you have reliable means of transportation?*

YesNo
Are you presently working in the trade you are applying for?*

YesNo
If yes, name of employer:
Are you currently registered in another apprenticeship program?*

YesNo
If yes: Where & When
Have you ever been registered with the Department of Labor?*

YesNo
If yes: Where & When
Education
High School Name * High School Location Dates Attended Did you graduate?Yes No GED*
Trade School Name Trade Skill Dates Attended Did you graduate?Yes No
College Major Dates Attended Did you graduate?Yes No
Additional Education (specify):
Work Experience

Begin with present job and list backwards. Please include all work experience.
Employer Name*
Dates Employed*
Employer Address*
Employer Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Position*
Reason for Leaving*
Employer Name*
Dates Employed*
Employer Address*
Employer Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Position*
Reason for Leaving*
Employer Name
Dates Employed
Employer Address
Employer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position
Reason for Leaving
Trade
Please indicate the trade you are most interested in:*

CarpentryElectricalHVACPlumbingSheet MetalWeldingBricklayerCement MasonOperating Engineer - Heavy Equipment
Statistical Data

THE FOLLOWING INFORMATION IS NEEDED FOR STATISTICAL PURPOSES ONLY. IT WILL NOT BE USED FOR ANY OTHER REASON, NOR WILL IT BE DISCLOSED.
How did you hear about the Build Mississippi Apprenticeship Program:*
Gender*

MALEFEMALE
Race/Ethnic Group*

Caucasion/WhiteAfrican American/BlackNative AmericanAsianHispanicPacific IslanderOther
References

Please provide three references. Please do not list anyone you are related to or in a romantic relationship with.
Reference 1:*

First NameLast Name
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:*
example@example.com
Reference 2:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Reference 3:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Release of Information

To prevent unwanted solicitation by outside organizations, I hereby request that the information contained in my apprenticeship application not be released to organizations unless affiliated with MCEF/Build Mississippi. In the event that information is released pursuant to a legal requirement, I would ask not to be solicited or contacted by the organization securing such information.
Signature for Release of Information*
Acknowledgement

I have read and understand that to be eligible for the Build Mississippi Apprenticeship Program, I must complete this application form. All the required documents must also be returned before an interview. The school tuition is NONREFUNDABLE after the first night of class. Tuition should be paid to Mississippi Construction Education Foundation. Programs are subject to cancellation due to insufficient enrollment. In the event of a cancellation a refund will be issued. In consideration of the opportunity to apply to the Build Mississippi Apprenticeship Program I agree that any dispute arising from my application to or my participation in the Apprenticeship Program will be taken to arbitration, not court. By signing this application, it verifies that all the above information is true and accurate to the best of my knowledge.
Signature for Acknowledgement*
Date Application completed*

MonthDayYear
Date
Should be Empty:

Adult Apprenticeship Application

QUALIFICATIONS FOR THE BUILD MISSISSIPPI APPRENTICESHIP PROGRAM

Personal Information

Emergency Contact Information

Additional Questions

Education

Work Experience

Trade

Statistical Data

References

Release of Information

Acknowledgement