EmailMeForm
IEC Fort Worth Apprenticeship Application
Personal Information
Name
*
First
MI
Last
Suffix
Nickname
*
Date of Birth
*
MM
/
DD
/
YYYY
Social Security Number
*
Driver's license number
*
Highest Educational Level (attained):
Please select
Attained High School Diploma
Attained High School Equivalency
Completed One or More Years of Post-High School Education
Attained Non-Degree Post-High School Technical or Vocational Certificate
Attained an Associate’s Degree
Attained a Bachelor’s Degree
Attained a Degree Beyond Bachelor’s
Sex/Gender
Male
Female
I Do Not Self-Identify
Ethnicity
Hispanic or Latino
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Black or African-American
White
Hispanic or Latino
Please select
Yes
No
Prefer not to answer
Are you a Veteran?
Yes
No
Do you have a Disability?
Yes
No
I Do Not Self-Identify
Contact:
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Address Type
Billing
Business
Home
Primary Phone
###
-
###
-
####
Primary Phone Type
Please select
Business
Business cell
Cell
Fax
Home
Secondary Phone Number
###
-
###
-
####
Secondary Phone Type
Please select
Business
Business cell
Cell
Fax
Home
Email
Are you a CLC student?
Yes
No
Governmental Information
Are you legally eligible for employment in the United States?
Yes
No
Comment on my response
Are you willing to take a Drug Test?
Yes
No
Are you registered with Selective Service?
Yes
No
N/A
Within the last 7 years, have you been convicted or pleaded no contest to or received deferred adjudication for any crimes including DWI? (excluding minor traffic violations)
Yes
No
Comment on my response
Do you have a Disability?
Yes
No
I Do Not Self-Identify
Category of Disability
(Check all that apply)
Physical, Chronic Health Condition
Physical, Mobility Impairment
Mental or Psychiatric Disability
Vision Related Disability
Hearing Related Disability
Learning Disability
No Disability
Do you receive State Developmental Disabilities Agency Services (SSDA)?
Yes (SSDA)
No
Do you receive local or state Mental Health Agency services (LSMHA)?
Yes (LSMHA)
No
Do you receive services under state Medicaid HCBS Waiver?
Yes (HCBS Waiver)
No
Military Service (if applicable)
Are you eligible for Veteran Education (V.A.) Benefits?
Yes
No
Years of service
Military Separation Date
MM
/
DD
/
YYYY
Are you an Eligible Veteran?
As an Eligible Veteran, I served in the active U.S. military, naval, or air service for less than or equal to 180 days, and was discharged or released from such service under conditions other than dishonorable; or,
As an Eligible Veteran, I served on active duty for more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve
I am (a) the spouse of an Eligible Veteran who died on active duty or of a service connected disability, (b) the spouse of any member of the Armed Forces serving on active duty who is listed in one or more of the following categories and has be
I do not meet any conditions described above as an Eligible Veteran.
Are you a Disabled Veteran?
Please select
Yes
No
List any duties or training received in the military applicable to electrical construction
Are you a transitioning Service member?
I am a person who is on active military duty status (including separation leave) with the U.S. armed forces and within 24 months of retirement or 12 months of separation from the armed forces.
I do not meet any conditions above as a transitioning Service member.
Are you a homeless Veteran?
Yes (see full text below)
I do not meet any conditions above as a homeless Veteran.
I (a) served in the active military, naval, or air service, and was discharged or released from such service under conditions other than dishonorable, and who lacks a fixed, regular, and adequate night time residence. This includes any primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution providing temporary residence for participants intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings.
Employment Information
Are you currently employed?
Yes
I am employed but received a Notice of Termination of Employment or my Military Separation is pending (I am within 24 months of retirement or 12 months of separation from the armed forces).
24-B. Not employed and I am seeking employment
Not employed and I am not actively seeking employment at this time.
Current/Most Recent Employer Name/Contact Information
May we contact this employer?
Yes
No
Second Most Recent Employer Name/Contact Information
May we contact this employer?
Yes
No
Third Most Recent Employer Name/Contact Information
Have you previous applied for this program?
Please select
Yes
No
May we contact this employer?
Yes
No
Are you a Migrant Seasonal Farmworker?
Please select
Yes, Not Absent from Home Overnight
Yes, I Travel to Job Site and Do Not Stay at Home
Yes, Not Absent Overnight and Stay at Home
Yes, Food Processing Worker
No, None of the Ab
Education Information
Have you previously applied for this program?*
Please select
Yes
No
More Information
Highest Grade Level Completed:
Please select
Middle School (6-8)
9th Grade
10th Grade
11th Grade
12th Grade
Did Not Complete Any School Grades
Highest Education Level Completed
Please select
Attained High School Diploma
Attained High School Equivalency
Completed One or More Years of Post-High School Education
Attained Non-Degree Post-High School Technical or Vocational Certificate
Attained an Associate’s Degree
Attained a Bachelor’s Degree
Attained a Degree Beyond Bachelor’s
Have you attended a Trade/Technical/Apprenticeship School?
Please select
Yes
No
Specify the number of semesters you have taken in each of the following subjects:
Algebra
Geometry
Chemistry
Physics
Drafting
Electricity
List any Honors/Recognitions:
List any Skills/Training that apply to the electrical construction field that you might have.
Have you had any work-related safety training?
Yes
No
Public Assistance Information
Have you received cash assistance or other supports services from the Temporary Assistance for Needy Families (TANF) agency in the last six months?
Yes
No
If you receive TANF cash assistance, are you within 2years of exhausting lifetime eligibility?
Yes
No
I currently receive or have received SSI Assistance in the last 6 months
Please select
Yes
No
I currently receive or have received SSDI Assistance in the last 6 months?
Please select
Yes
No
I am a Ticket to Work Program Ticket Holder?
Please select
Yes
No
I currently receive or have received State and/or Local government assistance in the last 6 months?
Please select
Yes
No
I currently receive or have received Refugee Cash Assistance (RCA) in the last 6 months?
Please select
Yes
No
Young Parent with Dependents (check all that apply)
Please select
I am less than 25 years old and I provide custodialcare for one or more dependents under age 18.
Question Removed
None of the above.
Young Adult Status
Please select
I am less than 25 years old and I do not currentlyattend school or other educational program and needadditional assistance to enter or complete an educationalprogram, or to secure and hold employment.
I am less than 25 years old and I attend school orother educational program and need additional assistance toenter or complete an educational program, or to secure and hold employment.
None of the above.
Young Adult Foster Care Status
Please select
I am less than 25 years old and I am currently in Foster Care.
I am less than 25 years old and I have aged out of the Foster Care system.
None of the above.
Homeless Status (check all that apply)
I do not have a fixed, regular, and adequate nighttime residence.
I share the housing of other persons due to loss of housing and economic hardship.
I live in a motel, hotel, trailer park, or campgrounddue to a lack of alternative adequate accommodations.
I live in an emergency or transitional shelter.
I am waiting for foster care placement.
I have a primary nighttime residence that is a public orprivate place not designed for or ordinarily used as a regularsleeping accommodation for human beings, such as a car,park, abandoned building, bus or train station, airport, or camping ground.
I am a migratory child who in the preceding 36months was required to move from one school district toanother due to changes in the parent’s or parent’s spouse’sseasonal employment in agriculture, dairy, or fishing work.
I am under 18 years of age and have left home or lastplace of legal residence without the permission of my family.
None of the above.
Supplemental Nutrition Assistance Program (SNAP)
Please select
I receive, or in the past 6 months have received SNAP assistance.
I am part of a family that receives or in the past 6months have received SNAP assistance.
None of the above.
Other Low Income Information (check all that apply)
Please select
I am part of a family with total family income thatdoes not exceed the higher of the poverty line or 70% of thelower living standard income level.
I receive a free or reduced price lunch where I attend school.
I have a disability and my own income is under thepoverty line but I am a member of a family whose income isat or above the poverty line.
None of the above.
English Language (check all that apply)
Please select
I have a limited ability in speaking, reading, writing or understanding the English language.
My native language is a language other than English.
I live in a family or community environment where a language other than English is the dominant language.
None of the above.
Cultural Barrier to Employment
Please select
I perceive myself as possessing attitudes, beliefs, customs or practices that influence a way of thinking, acting or working that may serve as a hindrance to employment.
Does not apply.
I do not want to provide this information.
Single Parent (check all that apply)
Please select
I am single, separated, divorced or a widowed individual who has primary responsibility for one or more dependent children under age 18.
I am a single, separated, divorced or a widowed individual who is pregnant.
None of the above.
I do not want to provide this information.
Displaced Homemaker
Yes (see below)
No
47-A. I have been providing unpaid services to family members in the home and a) have been dependent on the income of another family member but is no longer supported by that income; b) am the dependent spouse of a member of the Armed Forces on active and whose family income is significantly reduced because of a deployment, a call or order to active duty, a permanent change of station, or the service-connected death or disability of the member; and am unemployed or underemployed and experiencing difficulty in obtaining or upgrading employment.
Required Documentation
The required documentation listed below MUST be received at our admin@iecfwtc.org inbox before your application will be viewed:
– Drivers License/Photo ID
– Birth Certificate/Social Security Card
– Proof of High School Graduation/GED
– Selective Service Letter (males only)
– Copy of Electrical Apprentice License
Once your application is submitted, you will receive an email with instructions on where to send these documents. Or, you may upload these files below.
Driver's License
Social Security Card
Birth Certificate
Proof of High Graduation/GED
Selective Service Letter (males only)
Copy of Electrical Apprentice License
STAFF USE ONLY
Type in name and date that you processed the application.
Staff Name
Date Time
MM
/
DD
/
YYYY