Apprentice Application Form

Complete the following form. You will receive a confirmation email.

This system is secure with 128-bit TLS (SSL) security, and your information will be transmitted securely to IEC FW/TC.

Required fields are marked: *

Your name:*

Your email address:*

Your Social Security Number:*
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Your date of birth:*
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Your address:*


City, State and ZIP Code:*
,

Your phone number:*

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Are you legally eligible for employment in the United States?*
YES
NO

Date of employment eligibility, if applicable:
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Have you ever been Convicted or, pleaded No Contest to, or received Deferred Adjudication for any crime including DWI (exclude minor traffic violations) within the last 7 years?*
YES
NO

If YES, explain:

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Who referred you?*
Friend
Relative
Agency
Employer
Ad
Other

If you were referred by an ad, which publication?

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Will you work overtime?
YES
NO

Are you available for shift work?
YES
NO

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Have you previously applied for this program?
YES
NO

If yes, when?

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Are you registered with Selective Service?
YES
NO

If no, do you have proof of exemption?
YES
NO

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Educational Information

Are you a high school graduate?
YES
NO

If no, number of years of high school attended?

If you are not a high school graduate, do you have a GED?
YES
NO

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Have you attended college?
YES
NO

If yes, years attended?

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Have you attended a Trade / Technical / Apprenticeship school?
YES
NO

If yes, what type?

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Specify the number of semesters you have taken in each of the following subjects:
Algebra:
Geometry:
Chemistry:
Physics:
Drafting:
Electricity:

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List any honors or recognition you have received:

List any skills or training you have which may apply toward electrical construction:

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Job Related Information

Do you have a valid Texas Driver's License?*
YES
NO

Your Driver's License state and number:

Type of Driver's License (Class C, etc.):

Are you insurable to drive?*
YES
NO

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If required by a sponsoring employer, are you willing to take a drug test?
YES
NO

Have you had any work-related safety training?
YES
NO

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Military Experience Information

Branch of service:

Years served and rank:

List any duties or training received applicable to electrical construction:

Are you eligible for any V.A. education benefits?
YES
NO

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References
DO NOT LIST RELATIVES OR FORMER EMPLOYERS

Reference 1 Name:

Reference 1 Phone:

Reference 1 Occupation:

Reference 1 years known:

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Reference 2 Name:

Reference 2 Phone:

Reference 2 Occupation:

Reference 2 years known:

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Other Qualifications

List any other qualifications you have and believe would be important for consideration of this application:

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Employment Record
List your current or most recent employer first.

Are you currently working?
YES
NO

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Current or most recent employer:

May we contact this employer?
YES
NO

Company address:



Company phone:

Employed from date:

Employed to date:

Job Title:

Supervisor Name:

Rate of pay:

Brief description of work:

Reason for leaving:

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Next (second) most recent employer:

May we contact this employer?
YES
NO

Company address:



Company phone:

Employed from date:

Employed to date:

Job Title:

Supervisor Name:

Rate of pay:

Brief description of work:

Reason for leaving:

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Next (third) most recent employer:

May we contact this employer?
YES
NO

Company address:



Company phone:

Employed from date:

Employed to date:

Job Title:

Supervisor Name:

Rate of pay:

Brief description of work:

Reason for leaving:

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Representations and Waivers

I CERTIFY AND GUARANTEE THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND WITHOUT MENTAL RESERVATIONS. I UNDERSTAND THAT FALSIFICATION OF THIS APPLICATION MAY RESULT IN MY NOT BEING CONSIDERED FOR THE APPRENTICESHIP PROGRAM, OR IN THE EVENT I BECOME ACCEPTED, IN MY DISMISSAL.

I GRANT PERMISSION FOR THE INVESTIGATION OF ANY AND ALL STATEMENTS CONTAINED IN THIS APPLICATION AND I HEREBY RELEASE ALL PERSONS OR AGENCIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING THIS INFORMATION TO YOU.

*****PROSPECTIVE APPRENTICES WILL RECEIVE CONSIDERATION WITHOUT DISCRIMINATION BECAUSE OF RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, DISABILITY OR VETERANS STATUS. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.*****


By signing this form, I agree to the above (type your full name as a signature):
*

Today's date:


You will receive a confirmation email.

This system is secure with 128-bit TLS (SSL) security, and your information will be transmitted securely to IEC FW/TC.


IEC Fort Worth/Tarrant County Chapter

5809 East Berry Street
Fort Worth TX 76119
Phone: (817) 496-8422
Fax: (817) 496-8555

Independent Electrical Contractors Fort Worth/Tarrant County