Application for ABC Apprenticeship Program Info: First name:* Middle name:* Last name:* Suffix: Date of birth:* SSN:* Gender:MaleFemale Ethnicity:*American Indian Or Alaskan NativeAsian/Pacific IslanderBlackHispanicOtherWhite – Not Of Hispanic Orgin Veteran:YesNo Street:* Street 2: City:* State:* Zip code:* Primary phone number:* Email:* Apprentice type:*CarpentryDrywallElectricalGlazingHeavy Equipment OperationsHVACInstrumentationInsulatingIronworkingJumpstart Pre-Apprenticeship ProgramMasonryPipe FitterPlumbingSchool-To-Career Registered ApprenticeSheet MetalSprinkler Fitting Answers: Do you have your own transportation?*YesNo EMPLOYMENT STATUS Are you currently with a participating employed?*YesNo Employer’s name* Work phone Supervisor’s name Job description <br /><br /><br /> EDUCATION Please indicate last grade completed*CollegeHigh SchoolVoc/Trade Name/location of institution* Years attended Course of study APPLICANT PROFILE – This information is required by the Maryland Apprenticeship & Training Council. Are you physically able to perform the duties of a construction trade?*YesNo How did you hear about the apprenticeship program? “I understand that all of the following requirements must be submitted with completed application to be scheduled for an interview.” Please email or fax or mail the following requirements to: Fax: 410.821.0358 Email: apr@abcbaltimore.org Mail: 1220B E. Joppa Road, Towson, MD 21286 DOCTOR’S CERTIFICATE – You must obtain a doctor’s note stating that “YOU ARE PHYSICALLY ABLE TO WORK IN THE CONSTRUCTION FIELD”. This note must be signed by the attending physician stating the date you were examined, and the date must be within the last six months, and must be on the doctor’s letterhead or prescription pad. Any doctor’s note NOT having the above information will not be accepted. PROOF OF AGE – Provide one of the following: Birth Certificate, Selective Service Card or Driver’s License. COPY OF YOUR HIGH SCHOOL DIPLOMA or GED. PROOF OF WORK EXPERIENCE – You must obtain a letter from a current or previous employer stating the length of employment and the duties you performed, and must be signed by the employer. (Experience does not have to be in the selected trade but is preferred). VETERANS DISCHARGE (DD214)-IF APPLICABLE: You must supply a copy of your discharge papers if you served in the military. “I certify that to the best of my knowledge and belief, the above information is true and correct. I fully understand that it is my responsibility to provide my own transportation to and from all job sites and that the inability to do so may disqualify me from the ABC Apprenticeship Program.” Electronic signature* Date*
