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Applicant Information

Application Type
Last 4 Digits of SSN Address
Last Name
First Name City
Middle Initial State/Zip Code
Home Phone Email Address
Cell Phone Verify Email
Education

Highest Year of Education Completed High School(s)



College(s) or Vocational School(s)
Background

Do you have any trade experience? Do you have a valid Driver's License?
Have you applied with this apprenticeship program before? License #
If YES, how many times? Have you served in the US military?
Have you participated in an apprenticeship of any kind?
If YES, in what?
Interest & Ability

Check All That Apply






Surveying / Related Work Experience

1. Company Name Name of Supervisor
Address Employed From (mm/yyyy)
Employed To (mm/yyyy)
Phone Number Weekly Pay
State your Job Title and Describe your Work Reason for Leaving

2. Company Name Name of Supervisor
Address Employed From (mm/yyyy)
Employed To (mm/yyyy)
Phone Number Weekly Pay
State your Job Title and Describe your Work Reason for Leaving

3. Company Name Name of Supervisor
Address Employed From (mm/yyyy)
Employed To (mm/yyyy)
Phone Number Weekly Pay
State your Job Title and Describe your Work Reason for Leaving
Who Referred You to Our Program?

1. Reference Name Relationship
Reference Occupation Address
If this reference was a supervisor, list your last title with this employer.
Phone Number

2. Reference Name Relationship
Reference Occupation Address
If this reference was a supervisor, list your last title with this employer.
Phone Number

3. Reference Name Relationship
Reference Occupation Address
If this reference was a supervisor, list your last title with this employer.
Phone Number
EEOC Supplemental Information

This apprenticeship sponsor is committed to equal opportunity for all applicants. The recruitment, selection, employment and training of apprentices during their apprenticeship, shall be without discrimination because of race, color, religion, national origin, sex or age, except the applicant must meet the minimum age requirement as specified in the standards. The JATC does not and will not discriminate against a qualified individual with a disability because of the disability of such individual.

This information voluntarily provided below is simply for equal employment opportunity commission (EEOC) purposes. This information will assist us in our efforts to provide accurate information in compliance with EEOC regulations and requirements.

Date Of Birth Number of Dependents Number of Years You Have Been Employed
in any Occupation Full-Time to Date
(Except for Military Service)
Gender
Ethnicity











Statements Of Understanding

You must check ALL the Boxes.
If you need clarification on any item contact Southern California Surveyors Joint Apprenticeship Committee.














I have checked all the above to indicate my understanding, and state that, to the best of my knowledge, all information provided on this form is true and accurate. I hereby grant permission to all former employers and references listed to disclose any information concerning my past employment and/or qualifications. I agree that any false statements made by me in this application shall constitute grounds for disqualification of my selection or grounds for my discharge, if false information is discovered after being selected for apprenticeship.

I hereby apply for an apprenticeship indenture with this sponsor and agree that if selected, I will abide by all Standards, Rules and Policies covered by the Indenture (Apprenticeship Agreement).

Please provide your firstname and lastname between two forward slash "/" symbols in order to indicate your agreement to these terms. (Examples: /firstname lastname/, /John Doe/)
Digital Signature Date of Digital Signature

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Input the Characters from the image above then Click Verify CAPTCHA
Application Entry

In order to complete this application, please fill in all the information requested in this document.

Prior to submitting this document, you will be required to fill out the CAPTCHA (Completely Automatic Public Turing Test to Tell Computers and Humans Apart) before submitting this application.