florida carpenters training trust · pdf fileflorida carpenters training trust fund . united...
TRANSCRIPT
Florida Carpenters Training Trust Fund
United Brotherhood of Carpenters and Joiners of America 2840 NW 27th Avenue, Ft. Lauderdale, Florida, 33311~954.739.9200 ~ Fax 954.739.6461
TODAY’S DATE: _______________________ APPLICATION NUMBER: _______________ CRAFT: CARPENTER _______ PILE DRIVER _______ INTERIOR SYSTEM _______ NAME: ________________________________________________________________________ PHONE NUMBER: _______________________________________________________________ ADDRESS: ______________________________________________________________________ CITY: STATE ZIP CODE: EMAIL ADDRESS: ________________________________________________________________ RACE: WHITE ____ BLACK ____ HISPANIC ____ PACIFIC ISLANDER ____ ASIAN ____ AMERICAN INDIAN ____ SEX: MALE _____ FEMALE ______ I have received the Florida Carpenters Training Center Application Signature: ________________________________ Rev: (7.17.15)
3
Florida Carpenters Training Trust Fund
United Brotherhood of Carpenters and Joiners of America 2840 North West 27th Avenue ~~ Fort Lauderdale, Florida 33311
PH (954) 739-9200 ~ Fax (954) 739-6461
** I hereby make Application for Carpenter Interior Systems or Pile Driver Apprenticeship:
Date: Social Security: - - Email: Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Home Ph: Cell Ph: Emergency Ph:
Country or State of Birth: Date of Birth: / /
Ethnic: W: B: H: A: AI: Sex: Male: Female:
Resident Alien Card Number: Refugee Card Number:
Temporary Resident Alien Card Number:
Have you applied to an Apprenticeship Program before? Yes: No : Year?
Do you have the minimum tools on the tool list? Yes: No :
Have you ever worked in construction? Yes: No : Year?
Do you have a current Florida Driver’s license? Yes: No : Year?
Do you have your own transportation? Yes: No :
What grade in school did you complete? __________ Year: Diploma Yes:
No: G.E.D. Yes: No:
How did you learn about this Program? What is your reason for enrolling in this Program?
Is a language other than English spoken in the home? Yes: No: Do you have a first language other than English? Yes: No: Are you physically able to perform heavy construction work? Yes: No: Are you eligible for Veterans Benefits? Yes: No:
Date of Military Service entry: Released Date:
Are You a Vietnam Veteran? Yes: No: Other Veteran? Yes: No
I have read and understand this entire Application for Apprenticeship and my signature indicates all my responses on the Application are correct.
Signature Date Rev: (7.17.15)
4
Former Employer’s Information
Employer’s Name: _____________________________________________________ Employer’s Address: ___________________________________________________
___________________________________________________________________ May we contact your employer for reference? ______________________________ Employer's phone number: _____________________________________________ Supervisor's name: ____________________________________________________ Type of work Performed: _______________________________________________
___________________________________________________________________
___________________________________________________________________
Job sites worked on for this employer:_____________________________________ Starting Date: ____________________ Ending Date: ________________________ Starting Wage Rate: _____________Ending Wage Rate: ______________________ Reason for leaving: ___________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Office use only
Review by: ________________________________ Date: ______________ Rev: (7.17.15)
5
Former Employer’s Information
Employer’s Name: _____________________________________________________ Employer’s Address: ___________________________________________________
___________________________________________________________________ May we contact your employer for reference? ______________________________ Employer's phone number: _____________________________________________ Supervisor's name: ____________________________________________________ Type of work Performed: _______________________________________________
___________________________________________________________________
___________________________________________________________________
Job sites worked on for this employer:_____________________________________ Starting Date: ____________________ Ending Date: ________________________ Starting Wage Rate: _____________Ending Wage Rate: ______________________ Reason for leaving: ___________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Office use only
Review by: ________________________________ Date: ______________ Rev: (7.17.15)
6
Former Employer’s Information
Employer’s Name: _____________________________________________________ Employer’s Address: ___________________________________________________
___________________________________________________________________ May we contact your employer for reference? ______________________________ Employer's phone number: _____________________________________________ Supervisor's name: ____________________________________________________ Type of work Performed: _______________________________________________
___________________________________________________________________
___________________________________________________________________
Job sites worked on for this employer:_____________________________________ Starting Date: ____________________ Ending Date: ________________________ Starting Wage Rate: _____________Ending Wage Rate: ______________________ Reason for leaving: ___________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Office use only
Review by: ________________________________ Date: ______________ Rev: (7.17.15)
7
Former Employer’s Information
Employer’s Name: _____________________________________________________ Employer’s Address: ___________________________________________________
___________________________________________________________________ May we contact your employer for reference? ______________________________ Employer's phone number: _____________________________________________ Supervisor's name: ____________________________________________________ Type of work Performed: _______________________________________________
___________________________________________________________________
___________________________________________________________________
Job sites worked on for this employer:_____________________________________ Starting Date: ____________________ Ending Date: ________________________ Starting Wage Rate: _____________Ending Wage Rate: ______________________ Reason for leaving: ___________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Office use only
Review by: ________________________________ Date: ______________
Rev: (7.17.15)