AOA Apprenticeship Application

Why are you being asked to complete this form?

Because we are a sponsor of a registered apprenticeship program and participate in the National Registered Apprenticeship System that is regulated by the U.S. Department of Labor, we must reach out to, enroll, and provide equal opportunity in apprenticeship to qualified people with disabilities. To help us learn how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for apprenticeship, any answer you give will be kept private and will not be used against you in any way.

If you already are an apprentice within our registered apprenticeship program, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our apprentices at the time of enrollment, and then remind them yearly, that they may update their information. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obsessive compulsive disorder, impairments requiring the use of a wheelchair, and intellectual disability (previously called mental retardation).

[IJ Part 30 – Equal Employment Opportunity in Apprenticeship. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Apprenticeship website at https://www.doleta.gov/OA/eeo

Name
Address
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Sex
Ethnic Group
Race
Veteran Status
Highest Grade Level Achieved
Employment Status

Work Experience

List jobs in order, starting with your present of latest job. Include military experience, summer jobs, and part-time jobs.
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SPONSOR will not discriminate against apprenticeship applicants or apprentices based on race, color, religion, national 01igln, sex (including pregnancy and gender Identity), sexual orientation, genetic information, or because they are an individual with a disability or aperson40-years old or older. SPONSOR will take affirmative action to provide equal opportunity ln apprenticeship and will operate the apprenticeship program as required under Title 29 of the Code of Federal Regulations, part 30. Program Registration and Apprenticeship Agreement Office of Apprenticeship. U.S. Department of Labor Employment and Training Administration Voluntary Disability Disclosure 0MB No. 1205-0223 Expiration Date: 03/31/2023
Please check one of the boxes below:
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