Application Sheet Metal Institute Application Personal Information: First name:* Last name:* Date of birth: SSN:* Drivers license number: Gender: Male Female Ethnicity: American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Veteran: Yes No Street:* City:* State:* Zip code:* Primary phone number:* Primary phone type:* Cell Fax Home Office Other Pager Work Secondary phone number: Email:* Referral category:* Multi Craft Core Curriculum- MC3 Internet Teacher/Counselor Career Fair Employment Office Word of Mouth (E.g. friend or family member in the trade) Other Youth Trades Academy Oregon Tradeswomen (OTI) Portland Youth Builders Constructing Hope Portland Opportunities Industrialization Center (POIC) Advertisement Application: Which apprenticeship are you applying for?* Sheet Metal Worker Service Systems Technician A separate Pool of Eligibles is kept for each Region. Which region(s) are you applying for? (Hold down ctrl or cmd to select multiple regions.)* Region 1: Oregon: Benton, Clackamas, Clatsop, Columbia, Gilliam, Grant, Hood River, Lincoln, Linn, Marion, Multnomah, Polk, Sherman, Tillamook, Wasco, Washington, Wheeler and Yamhill Counties Washington: Clark and Skamania Counties Region 2: Douglas and Lane Counties Region 3: Coos County Region 4: Harney, Jackson, Josephine, Klamath, Curry and Lake Counties Region 5: Crook, Deschutes and Jefferson Counties Can you tell us in detail how you heard about our program?* Education How many years of formal education have you completed? (Example: High School graduate = 12 years, Bachelor's degree = 16 years) Have you submitted a final transcript showing you graduated from high school?* Yes No Enter the name and location of the high school from which you graduated and list your accumulative GPA. (Enter "N/A" if you received a GED)* Have you submitted documentation showing you earned your GED?* Yes No Enter each category's score from your GED. (Enter "N/A" if you graduated from high school)* Testing Have you turned in documentation showing Accuplacer test placement into Math 60, or above? (5 points for placing above Math 60)* Math 60 Above Math 60 N/A Have you turned in documentation showing AccuPlacer test placement into Writing 101, or above? (5 points for placing above Writing 101)* Writing 101 Above Writing 101 N/A Enter your AccuPlacer test information (location, score and placement). (Enter "N/A" if you did not take an AccuPlacer test)* Have you turned in documentation showing you earned the NCRC (Silver, or above) by taking the WorkKeys tests? (5 points for Gold, or above)* Platinum (scored 6, or above, on all three tests) Gold (scored 5, or above, on all three tests) Silver (scored 4, or above, on all three tests) N/A What was your score on the Applied Math WorkKeys test?* Silver (4) Gold (5) Platinum (6) Beyond (7) N/A What was your score on the Workplace Documents WorkKeys test?* Silver (4) Gold (5) Platinum (6) Beyond (7) N/A What was your score on the Graphic Literacy WorkKeys test?* Silver (4) Gold (5) Platinum (6) Beyond (7) N/A Work History List current, or most recent, employer (include city, state and phone number) and date range (From/To). Give Job Title, description of work performed and reason for leaving. (Please indicate whether we may contact this employer)* List other relevant employers (include city, state and phone number) and date ranges (From/To). Give Job Titles, descriptions of work performed and reasons for leaving. (Please indicate whether we may contact these employers)* Does your work history information entered above show Classified Worker experience? (5 points per 3 month period, 30 points max)* Yes No Does your work history information entered above show Sheet Metal experience? (3 points per 3 month period, 18 points max)* Yes No Does your work history information entered above show Construction experience? (2 points per 3 month period, 10 points max)* Yes No Does your work history information entered above show Construction related experience? (1 points per 3 month period, 5 points max)* Yes No Have you submitted a copy of your driver's license? (5 points)* Yes No Have you turned in documentation seeking 8 points for having completed one of the following: Oregon Tradeswomen, Cascadia Technical Academy, Constructing Hope, PCC Pre-Trades, Portland Youth Builders, Job Corps* Yes No Have you turned in documentation seeking 6 points for having completed one of the following: Lane County Pre-Apprenticeship for HS Youth, CTEC Salem/Keizer* Yes No Have you turned in a DD214 seeking 10 points for military service?* Yes No Have you turned in documentation seeking points for having passed a Geometry class? (4 points for C grade, 6 for B, 8 for A)* Yes No Have you turned in documentation seeking points for having passed a Trigonometry class? (4 points for C grade, 6 for B, 8 for A)* Yes No Have you turned in documentation seeking points for having completed: High school, Community College, or private classes with a grade of a "C" or better, in: shop, industrial technology, welding, drafting, blueprint, building construction and similar classes (5 pts per semester credit per class 15 points max)* Yes No Pre-Interview Statements Have you read the "ESSENTIAL FUNCTIONS JOB ANALYSIS" for a Sheet Metal Apprentice?* Yes No Related instruction includes five weeks per year, forty hours per week, Monday through Friday. You may be required to attend class on Saturdays, or in the evenings. Missing more class than the attendance policy allows will result in a fail for the week. Will this cause you any problems?* Yes No Do you understand that failure to attend school could result in the cancellation of your Apprenticeship Agreement, thereby causing you to lose your employment?* Yes No Do you have any plans that may interfere with a five-year Apprenticeship program?* Yes No Your Apprenticeship Agreement may be cancelled if you fail to comply with the standards of this trade, including: poor work reports, failing classes, failing to submit complete and accurate progress reports on time. Will this cause you any problems?* Yes No Are you aware that pre-employment drug testing is required?* Yes No Physical Requirements I am able to perform the tasks contained in this ESSENTIAL FUNCTIONS JOB ANALYSIS without reservations. (If you answer "No" to this question, you must list reservations in the follow-up question.)* Yes No I am able to perform the tasks contained in this ESSENTIAL FUNCTIONS JOB ANALYSIS with the following reservations. (If you answered "No" to the question above, please list your reservations in the space provided. If you answered "Yes" to the question above, please enter "N/A".)* By signing my electronic signature below I am indicating my understanding and stating that, to the best of my knowledge, all information provided on this form is true and accurate. I hereby grant permisssion 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 ground 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 the Standards, Rules, and Policies covered by the indenture (Apprenticeship Agreement). Applicant Signature: (By typing in your name you are stating all information entered is correct and truthful)* Application Date: (Enter the date as follows: MM/DD/YYYY. Example: 07/04/2020)*