University of Iowa Labor Center Preapprenticeship On-line Application

University of Iowa Labor Center

Quality Pre-Apprenticeship Program

Program Application

Return completed application by mail to: Labor Center, 100 BVC, Room W130, The University of Iowa, Iowa City, IA 52242-5000 OR by email to labor-center@uiowa.edu

APPLY BY SEPTEMBER 30, 2019 to be considered for Des Moines program starting Oct. 5

Today’s Date:

Your Information:

Name:

Address:

City:State:Zip

Email Address:

Cell Phone Number:   Alternate Phone Number:

Are you 18 years old or older? (check one)    Yes No 

If no, when will you turn 18? (month/year) /

Emergency Contact Information:

Name:

Address:

City: State: Zip

Phone Number:   Alternate Phone Number: Relationship to you:

Education:

Highest Grade Completed:     1  3  4  5  9 10111213+

Do you have a High School Diploma?  Yes  No      If no, do you have a GED Certificate?  Yes  No

Where and When did you earn your Diploma/GED? 

Did you take Algebra in High School and Receive a Passing Grade?  Yes No 

List any Vocational or Industrial Education Courses you have taken and passed:

Course & School: 

Course & School: 

List any other training programs in which you have participated:

Program Type of Training Program Completed?  Yes No

Program Type of Training Program Completed?  Yes No

List any Registered Apprenticeship Programs to which you have already applied:

RA Program        Trade

 Status of Application: 

RA Program        Trade

Status of Application: 

Employment Information:

Current employer:

Employer Location (City and State)

Years at current employment: 

What hours do you generally work? 

Are you willing to leave this job if you are accepted into a registered apprenticeship program?  Yes  No

List three most recent previous employers, starting with the most recent

Employer:

Employer Location (City and State)

Years with employer: 

Reason for leaving: 

Employer:

Employer Location (City and State)

Years with employer: 

Reason for leaving: 

Employer:

Employer Location (City and State)

Years with employer: 

Reason for leaving: 

Additional Personal Information:

How did you hear about the Labor Center Pre-Apprenticeship Program?

Is there a particular trade you are interested in pursuing as a career?

Transportation: 

(While the pre-apprenticeship program does not require a valid driver’s license, most Registered Apprenticeship Programs require either a valid driver’s license or reliable transportation in order to be accepted into the program.  We collect this information only to assist us in counseling you on appropriate programs to which you could apply.)

Do you have a valid driver’s license?  Yes    No

            If no, when will you again be eligible for a driver’s license?  

Do you have reliable transportation to get to worksites within 100 miles of Des Moines?  Yes No

Demographic Information:

(We are required to report certain summary demographic information to our funding sources.  No individually identifiable information will be reported.)

Age:    

Gender:   

Ethnicity (check one):  Hispanic    Not Hispanic 

Race (check all that apply): Black/African-American                      Asian              

 American Indian/Alaska Native           Native Hawaiian/Other

Pacific Islander                                    White

Are you a veteran of the United States armed forces?   Yes   No

If yes, branch of service:

Years on active duty: 

Training received while in service: 

Were you born in a country other than the United States?  Yes   No

Do you have a disability (a mental or physical impairment that may make it difficult for you to do a job, unless an accommodation were provided)?   Yes   No

If yes, nature of disability:

If yes, what type of reasonable accommodations do you believe would make it possible for you to perform most or all job duties:

Additional Support Services:

Is there any area in which you believe you would need additional support (such as child care assistance, transportation assistance, or other kinds of support) in order to complete the program successfully?   Yes   No

If yes, what type of support do you need? 

Required Signature

NOTICE: This program is an apprenticeship readiness program only. Participation in and/or completion of the program does NOT guarantee admission into an apprenticeship program, admission into a union, or employment in the construction industry. Decisions on such admissions or employment are made by the individual apprenticeship program, union, or employer, and not by this program. By signing this application and participating in this program, you indicate your agreement and understanding that no promises or guarantees of admission to an apprenticeship program or a union or employment in the construction industry have been made to you and that no one representing this program has the authority to make such promises or guarantees.

Signature: Date:

This workforce product was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on the linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This product is copyrighted by the institution that created it.

                                                   


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