Alabama Advanced Manufacturing Apprenticeship Program

SECTION 1: PROFILE INFORMATION

Name(Required)

First Last

LAST 4 Numbers of your Social Security Number(Required)

Race/Ethnicity(Required)

(Check all that apply.)

American Indian/Alaskan Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

Hispanic/Latino

White/Caucasian

Other

Gender(Required)

Male

Female

Do you have a disability (physical or mental impairment) that you acknowledge?(Required)

Yes

Are you a U.S. Citizen?(Required)

Yes

Are you eligible to work in the U. S.?(Required)

Yes

If you are not eligible to work in the U.S., explain why.

Military Status(Required)

(Jobs for Veterans Act applicable with priority status given to Veterans and eligible Veteran’s spouses.)

Transitioning Service Member (active-duty military within 24 months of retirement or 12 months of separation)

Veteran (more than 180 days served)

Veteran (less than 180 days served)

Military Spouse (see spouse eligibility) *spouse of member that died on active duty or of a service-connected disability *spouse of member of Armed Forces that was classified as missing in action, captured in line of duty, forcibly detained or interned in the line of duty by foreign power within 90 days of application *spouse of Veteran who has total disability resulting from service-connected disability or who died while a disability was being evaluated

Not Applicable/No Military Service

SECTION 2: CONTACT INFORMATION

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Your Cell Phone(Required)

Your Home Phone(Required)

Emergency Contact Person Name

First Last

Emergency Contact Person Phone

SECTION 3: EDUCATION INFORMATION

Secondary Educational Level Completed:(Required)

HS Diploma

GED

Individualized Education Program

Highest grade completed:(Required)

Highest post-secondary educational level completed (check all that apply):(Required)

One of more years of post-secondary education

Associate Degree

Bachelor Degree

Graduate Degree

Industry Certifications or Professional Licenses

If you checked any of the above, please provide list of degree(s), credentials, licenses and/or certifications obtained:

Are you currently enrolled in an apprenticeship program (registered or unregistered)?(Required)

Yes

If enrolled in apprenticeship, please provide program name:

Primary Language:(Required)

English

Other

Reason for participating in training (check all that apply):(Required)

Reason for participating in training (check all that apply):

Gainful Employment

Retain Employment

Promotion/Raise

Upgrade Skill Sets

Other

SECTION 4: EMPLOYMENT INFORMATION

Are you currently employed? (Paid)(Required)

Yes

Are you currently employed? (Unpaid)(Required)

Yes

Work Phone

Current Position

Which of the following describes your employment status (check all that apply)?(Required)

Employed (but seeking increase skills to earn promotion, wage increase or obtain new employment)

Employed (but received notice of termination of employment or military separation pending)

Underemployed (employed only part-time, temporary, or sporadically or employed full-time, but at a job below skills, education, training or past pay level)

Unemployed (due to company/facility layoff or closure)

Unemployed (seeking employment)

Long-term Unemployed (more than 27 weeks)

Not in Labor Force (Not employed and not seeking employment – includes incarcerated)

Have you ever been arrested and/or convicted of a felony and/or misdemeanor that resulted in legal proceedings, criminal record and/or incarceration?(Required)

Yes

Check all that apply to you and/or your family (currently and/or in the last 6 months):

Certification

I certify that the statements on this application are true and complete to the best of my knowledge. I hereby waive my rights under FERPA and allow the release of the above information to the ALAMAP Project team. I understand that my information will be released to the US Department of Labor to report employment, wage, and other information needed to verify training progression, completion, and training outcomes under the ALAMAP Project, an Alabama Community College System initiative funded through a US DOL ETA Scaling Apprenticeship Through Sector-Based Strategies grant.

Type your name as your signature.(Required)

Date(Required)

Participant Application

SECTION 1: PROFILE INFORMATION

SECTION 2: CONTACT INFORMATION

SECTION 3: EDUCATION INFORMATION

SECTION 4: EMPLOYMENT INFORMATION

Certification

Campus Locations

Get Connected

Quick Links