Building Pathways Registration

1. Applicant basic information

First name:

Middle initial:

Last name:

Email address: (required)

Street address:

Unit number:

City/Town:

State:
--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Home phone:

Cell phone:

Best way to reach me:

home phonecell phoneemail

2. Applicant demographic information

Gender:

malefemale

Ethnicity:

Hispanic/LatinoNot Hispanic/Not Latino

Race:
--- Black or African American Asian American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander White

Date of Birth:

Veteran (Yes/No):

Date of discharge:

Citizenship:

US citizenresident alien

If not an US citizen, do you have a work visa?

yesno

Were you born in the United States?

yesno

3. Applicant educational background

highest-level-of-schooling-that-you-have-completed
less than 9th grade 9th-12th grade, no diploma high school diploma ged/high school equivalency - other post‐secondary training some college, no degree associate’s degree (2‐year) bachelor’s degree (4-year) master’s and above

Name of last school attended:

Major course of study:

Dates attended:

Start date

End date

Are you still attending school?

yesno

If you attended a vocational-technical high school or technical post-secondary school, please state:

Subject area:

Dates attended:

Start date

End date

Please list any credentials or certificates you hold:

Type:

Issued by:

Date issued:

Type:

Issued by:

Date issued:

Type:

Issued by:

Date issued:

4. Applicant employment - beginning with your present or most recent employment, please list the last 2 positions you have held. Include any unpaid work experience.

Most recent employer:

Phone:

Address:

Supervisor:

Job title and description:

Hours worked weekly:

Hourly wage:

Employment dates:

Start date:

End date:

I am still working here

Reason for leaving:

lay offcompany closedother

5. Are you at least 18 years of age?

yesno

If no, you are not eligible to apply for this program until you reach 18 years of age.

6. Would you be willing to take a drug/alcohol test to become accepted into the program?

yesno

7. Would you be willing to take a basic math and reading comprehension assessment?

yesno

8. Do you currently have a valid driver’s license?

yesno

You must have a valid driver’s license for admission into Building Pathways CT. If you do not currently hold a valid driver’s license, you must have a learner’s permit at the time you submit the application and a valid driver’s license by the 1st day of program admission (if accepted).

9. Do you own or have daily access to a vehicle that runs?

yesno

If yes, is your vehicle insured?

yesno

If you do not have daily access to a vehicle, how do you plan to get to class?:

When you do find work, how will you commute to construction sites?:

10. List all tools you have operated successfully at work or home (if any), e.g., hammer, power drill, etc.

List all the tools you have operated successfully at work or home (if any), e.g.,hammer,power drill:

11. Do you know anyone in the construction trades?

yesno

If yes, please identify his or her occupation and relationship to you:

12. Have you had any previous introduction to construction careers or ever applied for or participated in a building trades apprenticeship program?

yesno

If yes, please explain:

13. Why do you want to enter into a career in construction and what makes you a good candidate for this work?

14. Why should you be chosen to participate in Building Pathways CT?

15. You must provide at least one letter of professional reference, preferably from an employer or coworker, (not a friend or family member) with your application. The letter must be received by the workplace at the required information session.

The reference letter must include the reference’s name, address, phone number and signature, and should address the following qualities about you:

• reliability
• communication skills
• motivation and/or leadership skills
• ability to work with others
• respect for others

16. Have you ever been convicted of a felony?

yesno

If yes, explain briefly the nature and dates(s) of the conviction, and dates of release from incarceration. (note: a "yes" answer does not exclude you from training.)

17. Do you have any physical or other difficulties that would impair your ability to work in construction?

yesno

If yes, please explain why:

18. How did you hear about Building Pathways CT?

Work PlaceFacebookBuilding Pathways CT BrochureAmerican Job Centerfriend or relativecommunity organizationOther

If other, please specify:

DISCLAIMERS AND SIGNATURE

I certify that my answers on this application are true and complete to the best of my knowledge. I understand that if the information provided leads to admission into the Building Pathways Program, false or misleading information may result in my release. I authorize The Workplace and Building Pathways to share this information with each other. I release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. You are hereby authorized to make any investigation of my personal history, academic/professional credentials, military service records, criminal, driving, and financial records through any investigative or credit bureaus of your choice. This waiver does not permit the release or use of disability‐related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Notice: 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 program. By signing this application and participating in this program, you indicate your agreement and understanding that no promises or guarantees of admission to an apprenticeship program or a union or employment in the construction industry have been made to you and that no one representing this program has the authority to make such promises or guarantees./p>

All applications are accepted on a rolling basis and all interested in a career in the Connecticut Building Trades are encouraged to apply. Those applicants who were not accepted initially are welcome to re-apply. All questions on individual applications should be referred to Building Pathways CT, a Connecticut AFL-CIO John J. Driscoll United Labor Agency program.

Signature (type name):

Date: