Apply Apprenticeship Readiness Program Application Form DATE: MM slash DD slash YYYY CMV CDL Last Name First Name Full Middle Name Place of Birth (CITY & STATE): Date of Birth: MM slash DD slash YYYY Copy of Birth Certificate Must Be ProvidedPresent Street Address City/State Zip Code Permanent Address City/State Zip Code Home Phone: Cellular Phone:*Email* EDUCATION: High School Attended: G.E.D. Date of Graduation: MM slash DD slash YYYY Date Obtained: MM slash DD slash YYYY Copy of Diploma Attached: Yes No Copy of Certificate of Completion Attached: Yes No College/University: DRIVERS LICENSE: Issuing State: License No. Do You Own A Vehicle: Yes No AUTHORIZATION/ACKNOWLEDGMENTS: APPRENTICESHIP READINESS PROGRAM: I understand and acknowledge that this program is an Apprenticeship Readiness Program only. Participation in and/or completion of the Program does not guarantee admission into an apprenticeship program, admission into a union or employment in the construction industry. Decisions on such admissions or employment are made by the individual apprenticeship program, union or employer and not by this Apprenticeship Readiness Program. By signing this application and participating in this program, I agree and understand that no promises, or guarantees, express or implied, of admission to an apprenticeship program or a union or employment in the construction industry have been made and that no one representing this program has the authority to make such promises or guarantees express or implied. PHOTO/AUDIO/VIDEO RELEASE: I authorize the Apprenticeship Readiness Program and the North Americas Building Trades Union to record my image and give the Apprenticeship Readiness Program and North Americas Building Trades Union and all persons or entities acting pursuant to their permission or authority, all rights to use the recorded images. I understand that said images and/or audio will be used for educational, advertising, and promotional purposes in all conventional and electronic media, and any future media. I also authorize the use of any printed material in connection therewith. I understand and agree that these images and/or audio may be duplicated, distributed with or without charge, and/or altered in any form or manner without future/further compensation or liability, in perpetuity. PRE-ADMISSION AND RANDOM ALCOHOL AND DRUG SCREENING: I further understand and acknowledge that should I be admitted into the Apprenticeship Readiness Program that I will be subject to random alcohol and drug screening throughout the duration of the training program at the expense of the Apprenticeship Readiness Program. I understand that compliance with my consent to participate in Pre-Admission and Random Alcohol and Drug Screening is a condition of being accepted into and remaining a participant in the Apprenticeship Readiness Program. Should I refuse to submit to either a Pre-Admission or any random alcohol and drug screening my application will be denied or I will be terminated from the program immediately. I further understand that acceptance into and continuing as a participant in the Apprenticeship Readiness Program is contingent upon negative alcohol and drug screening results. VERIFICATION OF INFORMATION: Authorization is granted to former employers and individuals listed in this application to release information on my ability, performance and verification of matters stated. I understand that the Apprenticeship Readiness Program reserves the right to verify any and all information on employment applications and any other related documents during both the application process and acceptance process. Any falsification, misrepresentation or omission of relevant information will be grounds for cancellation of this application or termination from the Apprenticeship Readiness Program. Felony or Misdemeanor Conviction: If you answer yes to either question, provide details below: A conviction will not necessarily disqualify you from employment. The nature of the violation and all other appropriate circumstances will be considered.Have You Ever Been Convicted of a Felony? Yes No Have You Ever Been Convicted of a Misdemeanor Within the past 7 Years? Yes No Applicants Signature Date: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.