Apprenticeship Application

Applicant Information

Applying To
Local Lodge

L-026, Statesboro, GA	L-083, Kansas City, MO (MO, KS, NE, IA)	L-455, Muscle Shoals, AL
L-037, Slidell, LA	L-105, Piketon, OH	L-456, Rock Hill, SC (NC & SC)
L-040, Eastern KY	L-108, Birmingham, AL	L-587, Orange, TX
L-040, Western KY	L-110, Hattiesburg, MS	L-592, Tulsa, OK
L-045, Zone-45, Richmond, VA	L-132, La Marque, TX	L-667, Winfield, WV
L-045, Zone-193, Baltimore, MD	L-433, Tampa, FL	NTDL-2020, Southeastern US
L-069, Little Rock, AR	L-454, Chattanooga, TN	U.S. Army, Ft. Moore CSP
L-074, Houston, TX

Application Type

Apprenticeship ApplicationU.S. Army, CSP

Social Security Number

Address

Last Name

First Name

City

Middle Initial

State/Zip Code

Home Phone

Email Address

Cell Phone

Verify Email

Education

Highest Year of Education Completed	High School(s)
High School Diploma General Education Certificate (G.E.D.) DD214 from The U.S. Armed Forces


	College(s) or Vocational School(s)

Background

Yes	No	Are you a Veteran of the U. S. Military?
Yes	No	Have you attended a Vocational/Technical School?
If YES, List School and Credentials / Diplomas Earned.

Yes	No	Have you ever been indentured into the Boilermakers National Apprenticeship Program?
If YES, List Area and Year.

Local Lodge Opportunities

Do you wish to be contacted about apprenticeship opportunities at other area lodges?

L-026, Statesboro, GA	L-083, Kansas City, MO (MO, KS, NE, IA)	L-455, Muscle Shoals, AL
L-037, Slidell, LA	L-105, Piketon, OH	L-456, Rock Hill, SC (NC & SC)
L-040, Eastern KY	L-108, Birmingham, AL	L-587, Orange, TX
L-040, Western KY	L-110, Hattiesburg, MS	L-592, Tulsa, OK
L-045, Zone-45, Richmond, VA	L-132, La Marque, TX	L-667, Winfield, WV
L-045, Zone-193, Baltimore, MD	L-433, Tampa, FL	NTDL-2020, Southeastern US
L-069, Little Rock, AR	L-454, Chattanooga, TN	U.S. Army, Ft. Moore CSP
L-074, Houston, TX

Boilermaker Related Tasks

If you have ever worked or participated in any activities that may be related to tasks performed by boilermakers, list tasks below.
If you have a welding certification in the ASME 6-G position with a company or Common Arc, attach a copy to your application documents.

CHECK ONLY YOUR HIGHEST QUALIFICATION

Gr-1: Certified Tube/pipe Welder (Contractor Certified)

Gr-1: 1,500+ Hours Field Experience In Boilermaker Related Work

Gr-2: Certified Plate Welder (Contractor Certified)

Gr-2: 1,000+ Field Hours Experience In Boilermaker Trade

Gr-3: Certificate Of Completion From Post-High School Welding Program

Gr-4: No Welding Experience

EEOC Supplemental Information

The Boilermaker National Joint Apprenticeship Program will not discriminate against apprenticeship applicants or apprentices based on race, color, religion, national origin, sex (including pregnancy and gender identity), sexual orientation, age, genetic information, or because they are an individual with a disability. The Boilermaker National Joint Apprenticeship Program will take affirmative action to provide equal opportunity in apprenticeship and will operate the apprenticeship program as required under Title 29 of the Code of Federal Regulations, part 30.

You have the right to file a discrimination complaint with the Equal Employment Opportunity Commission (“EEOC”) and/or the Registration Agency with whom the apprenticeship program is registered. Please see the attached notice regarding your right to file such a complaint and the procedures for doing so.

You also have the right to file complaints of discrimination and/or harassment with the Boilermaker National Joint Apprenticeship Program and/or the Area Apprenticeship Programs using the complaint procedures set forth in the Area Program’s Discrimination & Harassment Policy. A copy of this policy will be provided to you at the beginning of your apprenticeship and is immediately available upon request.

This information voluntarily provided below is simply for equal employment opportunity commission (EEOC) purposes. This information will assist us in our efforts to provide accurate information in compliance with EEOC regulations and requirments.

Date Of Birth

Gender

Ethnicity

Female Male

Caucasian	African American
Native American	Hispanic
Asian, Pacific Islander

Statements Of Understanding

You must check ALL the Boxes. If you need clarification on any item contact Boilermakers SAJAC.

I understand that if selected, I may be required to work in confined spaces.

I understand that if selected, I may be required to work at varying heights above the ground.

I understand that if selected, I may be required to work in Nuclear Facilities.

I understand that if selected, I may be required to work under other hazardous conditions.

I understand that if selected, I may be required to travel out of town for work opportunities.

I understand that if selected, I will be required to comply with the BNAP Drug and Alcohol Screening Program.

I understand that if selected, I will be required to complete Related Study Courses and attend class on my own time.

I certify that I am at least 18 years of age and have a High School Diploma or GED.

I have the legal right to work in the United States of America.

Applications are valid for a period of 2 years. Contact the SAJAC office at 813-633-5500 for any changes to a current application.

I understand that I will receive an email containing instructions to complete the application process. Failure to follow these instructions will disqualify my application.

I have checked all the above to indicate my understanding, and state that, to the best of my knowledge, all information provided on this form is true and accurate. I agree that any false statements made by me in this application shall constitute grounds 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 Standards, Rules and Policies covered by the Indenture (Apprenticeship Agreement).

Please provide your firstname and lastname between two forward slash "/" symbols in order to indicate your agreement to these terms. (Examples: /firstname lastname/, /John Doe/)

Digital Signature

Date of Digital Signature

Input the Characters from the image above then Click Verify CAPTCHA

Application Entry

In order to complete this application, please fill in all the information requested in this document.

Prior to submitting this document, you will be required to fill out the CAPTCHA (Completely Automatic Public Turing Test to Tell Computers and Humans Apart) before submitting this application.

Boilermakers SAJAC - www.sajac-boilermakers.org