• Apprenticeship Pre-Registration Form

    Apprenticeship Pre-Registration Form

  • Apprentice Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Apprentice Registration Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Did the Apprentice Complete a Pre-Apprenticeship Program?

  • ***If between the ages of 18 & 25 and you completed school in Vermont:

  • Apprentice Demographics

    This information is voluntary and is used to ensure compliance with equal employment opportunity laws.
  • Ethnicity
  • Sex
  • Race (select all that apply)
  • Education
  • Veteran Status

  • Veteran - a person who has served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable.

    Non-Veteran, Other Eligible Individual - a person who is a dependent or surviving spouse or child of a Veteran, and who is eligible for certain G.I. Bill and other VA administered educational assistance benefits provided under Title 38 of the U.S. Code.

    Veteran, Eligible - a Veteran who is eligible for certain G.I. Bill and other VA administered educational assistance benefits provided under Title 38 of the U.S. Code.

  • Relevant Employment and Training Histrory

    This information is used to determine advanced standing in the program

  • Please list employment relevant to this occupation.

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year
    • Add Additional Relative Employment History  
    • Start Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • Collapsable Stopper 
    • Add Additional Relative Employment History 
    • Start Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • Collapsable Stopper 

    • Please list training or coursework relevant to this occupation.

    • Start Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • Add Additional Relative Employment History 
    • Start Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • Collapsable Stopper 
    • Add Additional Relative Employment History 
    • Start Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • End Date
       - -
      2 digit month, 2 digit day, 4 digit year
    • Collapsable Stopper 

  • Vermont Department of Labor

    Voluntary Disability Disclosure
  • Please select one of the options below:
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Why are you being asked to complete this form?

    Because we are a sponsor of a registered apprenticeship program and participate in the National Registered Apprenticeship System that is regulated by the U.S. Department of Labor, and overseen by the Vermont Department of Labor, we must reach out to, enroll, and provide equal opportunity in apprenticeship to qualified people with disabilities.[1] To help us learn how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for apprenticeship, any answer you give will be kept private and will not be used against you in any way.

    If you already are an apprentice within our registered apprenticeship program, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our apprentices at the time of enrollment, and then remind them yearly, that they may update their information. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

    How do I know if I have a disability?

    You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obssive compulsive disorder, impairments requiring the use of a wheelchair, and intellectual disability.

     

    Part 30 – Equal Employment Opportunity in Apprenticeship. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Apprenticeship website at https://www.apprenticeship.gov/eeo

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