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,
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) *
