EmailMe Form - Apprentice Application

Name *

First Middle Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Cell Phone *

### - ### - ####

Social Security Number *

Sex on government issued ID:

Male

Female

Participant did not self-identify

Are you 18 years or order? *

Date of Birth *

MM / DD / YYYY

Ethnicity *

Race *

Are you a US citizen? *

Yes

No

Are you eligible for employment in the United States? *

Level of Completed Education *

Do you have a vehicle or reliable transportation? *

Yes

No

Drivers License Number *

State of Drivers License *

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

Yes

No

If yes, please explain, include date(s).

Emergency Contact

Name *

First Last

Relationship *

Cell Phone *

### - ### - ####

Do you have a Disability?

Disability Status *

Yes, I have a disability or have a previous disability

No, I do not have a disability

I do not wish to answer

If yes, I am concerned my disability may create significant challenges to obtaining and retaining employment *

Yes

No

Government/Military

Male applicant, are you registered with Selective Services? *

Yes

No

Female (N/A)

If NO, please visit https:www.sss.gov/register/

Veteran Status (Select all that apply) *

Are you eligible for V.A. benefits? *

Yes

No

N/A

If YES, have you used your benefits with another institution? *

Yes

No

N/A

Please list the name(s) where you V.A. benefits were used.

Employment History

Do you need IEC to seek employment on your behalf with an electrial contractor? *

Yes

No

If you selected "YES", would you be willing to travel out of state for jobs?

Yes

No

Are you currently employed with an IEC Dallas Member? *

Yes

No

Name of current or most recent employer *

May we contact the listed employer *

Yes

No

Company Phone *

### - ### - ####

Job Title *

Start date of employment *

End date of employment (if applicable)

Supervisor Name *

Brief description of work performed *

Reason for leaving (if applicable)

Documents

Upload a copy of your Drivers License *

Upload a copy of your Social Security Card *

Upload High School Diploma, GED or equivalent. *

Upload Selective Services registration confirmation

Upload State Apprenticeship License *

www.tdlr.texas.gov

Upload work VISA

DD214 (if appliciaple)

Program Information

Have you previously applied for this program? *

Yes

No

For which term do you seek admission? *

How did you hear about IEC's Apprenticeship Program?

If you selected "Other" or "Family/Friend", please list name and or source below.

Physical Functions Essential to the Job – Applicant must:

- Be able to bend, stoop, squat, crawl, climb, kneel, balance, push, pull, and reach overhead.
- Be able to Lift and carry 51lbs
- Be able to Engage in repetitive use of arms, hands, and fingers for the duration of the work day.
- Be able to Maintain constant mobility on your feet for the duration of work hours.
- Be able to Climb ladders of all types.
- Perform overhead work for the duration of full-day assignments.
- Be able to make transitions between parking areas and construction work areas, gaining access to all levels of the building, even if the only means
is by O.S.H.A. approved site construction ladder or stairs still under construction but acceptable and safe.
- Possess good vision (normal or corrected).
- Possess good hearing (normal or corrected).
- Possess ability to read and comprehend written instructions, including jobsite directions, maps, and instructional materials.
- Take responsibility for securing tools and materials from storage areas to complete assigned tasks.
- Read, comprehend, and communicate in English.

Are you able to meet all of the listed qualifications and perform the described physical functions essential to the job? *

Yes

No

Standards of Apprenticeship

This document is an overview of the standards for IEC Dallas Chapter under which we operate and administer the Apprenticeship Program. The program is registered with the Office of Apprenticeship, U.S. Department of Labor. Please copy and paste link to view the Standards of Apprenticeship

https://www.iecdallas.com/uploads/1/3/7/5/137506933/dol_dallas_standards_-_2023.pdf

I have read and I understand the Standards of Apprenticeship. *

Yes

No

Employment with IEC Contractor Member

To fulfill the requirement that an Apprentice work full time while attending school, IEC Dallas will arrange for you to interview with Contractor members regarding employment. Applicants for the Apprenticeship Program are to be provided no more than three (3) contractor members to interview. The applicant will not be eligible to enter the program until hired by an IEC Contractor Member.

I have read and I understand the Employment with and IEC Contractor Member *

Yes

No

Apprentice-Employer Relationship Commitment

While employed by the Member Contractor, the Apprentice will abide by that Contractor's policies and instructions.

The Apprentice is not to transfer from one Contractor to another. Under NO CIRCUMSTANCE will an apprentice seek a job with another Member Contractor while in the program. To do so is grounds for automatic termination from the program.

I have read and I understand the Apprenticeship-Employer Relationship Commitment. *

Yes

No

Do you authorize IEC Dallas to use your information for Department of Labor registration purposes. *

Yes

No

Do you authorize IEC Dallas to use your information for Texas Workforce Commission registration purposes? *

Yes

No

I understand that there is a non-refundable Application fee of $40 that must be paid before my application is processed? *

Yes

No

I certify and warrant that all representations and statements made on this Application are true and complete to the best of my knowledge and are made without mental reservations. I understand and acknowledge that all representations and statements made in this application are intended by me to be relied-upon by IEC Dallas in qualifying and selecting Apprenticeship Program candidates, and that falsification of any element of this Application may result in my not being considered for the IEC Dallas Apprenticeship Program or, in the event l am admitted to the IEC Dallas Apprenticeship Program, in my dismissal from the Apprenticeship Program. I further acknowledge that all information contained in this Application is intended to be relied-upon by prospective employers participating in the IEC Dallas Apprenticeship Program. *

Clear

Signature of Applicant

Date *

MM / DD / YYYY

Payment Information

Name as it appears on card *

First Last

Credit Card Number *

Expiration: *

CVV: *

Zip Code *