Ironworkers Local 112 Apprenticeship Application

LOCAL 112 IRONWORKERS APPRENTICE TRAINING and RETRAINING
Application Date*

MonthDayYear
Date
3003 North Main Street

East Peoria, Illinois 61611

Phone (309) 699-6489 Fax (309) 699-6480

Apprenticeship Coordinator: Joseph Reising

Email: jreising112@gmail.com
Have you read and signed off on the Apprenticeship Standards? Please do so before continuing to fill this form out.
Will you need a Spanish version for the aptitude test?*

YesNo
APPLICANT INFORMATION
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
EMPLOYMENT ELIGIBILITY
Are you legally eligible to work in the United States?*

YesNo
Do you have a valid driver's license?*

YesNo
State Issued*
License #*
EDUCATION
High School Name*
Did you graduate?*

YesNo
If you answered no above, do you have a GED?*

YesNoN/A, I graduated.
Year of Completion
College/Trade School if any
If yes, years completed
Did you graduate?

YesNo
MILITARY SERVICE
Are you a military veteran? If no, skip to the next section

YesNo
Branch
Dates of Service

MonthDayYear
Date
Rank at Discharge
SKILLS & EXPERIENCE
Do you have any experience in the following areas? (Check all that apply)

ConstructionWeldingRiggingBlueprint ReadingRebar InstallationSteelErectionConcrete WorkOther
List any certifications (eg., OSHA 10/30, First Aid, CPR, Welding, etc.)
PHYSICAL REQUIREMENTS
Are you able to lift 50 lbs.?*

YesNo
Are you able to work at heights?*

YesNo
Are you able to work in various weather conditions?*

YesNo
Are you able to pass a drug screening and physical exam?*

YesNo
PERSONAL STATEMENT
If accepted, do you agree to have satisfactory completion of both On the Job Training and Related Classroom Instruction prior to becoming a Journeyman Iron Worker?*

YesNo
Do you like to work with other people?

YesNo
Have you ever been fired from an employer?

YesNo
Have you been convicted of a felony?*

YesNo
If so, explain
Briefly explain why you want to become an Ironworker Apprentice*
REFERENCES
Name
Phone
Relationship
Company
Title
Name
Phone
Relationship
Company
Title
EMPLOYMENT HISTORY
Employer
Job Title
Dates Employed

MonthDayYear
Date
Phone Number
Duties
Employer
Job Title
Dates Employed

MonthDayYear
Date
Phone Number
Duties
Drivers License

Cancelof
High School Diploma or GED

Cancelof
Birth Certificate or Social Security Card

Cancelof
Military Form DD-214

Cancelof
SIGNATURE
I hereby certify that all information in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission may disqualify me from consideration or result in dismissal from the program. By signing this I awknowledge that I have read and understand the Standards of Apprenticeship.
Applicant Signature*

Clear
Application Date*

MonthDayYear
Date
Should be Empty:

LOCAL 112 IRONWORKERS APPRENTICE TRAINING and RETRAINING

APPLICANT INFORMATION

EMPLOYMENT ELIGIBILITY

EDUCATION

MILITARY SERVICE

SKILLS & EXPERIENCE

PHYSICAL REQUIREMENTS

PERSONAL STATEMENT

REFERENCES

EMPLOYMENT HISTORY

SIGNATURE