Fillable Printable APPRENTICE AGREEMENT - California
Fillable Printable APPRENTICE AGREEMENT - California
APPRENTICE AGREEMENT - California
A B C D Official Use
D. O. Gender Ethnic Dependent
s
Education STATUS
APPRENTICE LAST NAME, FIRST NAME MIDDLE
A
PPRENTICE ADDRESS (NUMBER AND STREET / CITY, STATE & ZIP)
BIRTHDATE (mm/dd/yyyy)
Yes: No:
OCCUPATION
TERM OF APPRENTICESHIP STRAIGHT T IME
Hours Within Years Hours per day: 8 Hours per week:
This agreement is between the above named apprentice employed by the below named employer, and
DAY MONTH YEAR SIGNATURE OF APPRENTICE
NAME OF EMPL OYER
SIGNATURE - - SECRETARY / CHAIR / COORDINATOR DATE
A
DDRESS
SIGNATURE -- APPRENTICESHIP CONSUL TANT DATE
for the Administrator of Apprenticeship
DAS 1 (REV. 3/12) APPRENTICE AGREEMENT
E
FILE NUMBER Yrs Employ
F - VETERAN
State of California -- Department of Industrial Relations --DIVISION OF APPRENTICESHIP STANDARDS
APPRENTICE AGREEMENT
SOCIAL SECURITY NUMBER
PROGRAM SPO NSOR
AGREEMENT: The undersigned parties mutually agree that they will us e their best endeavors to secure employment and training for
the apprentice. The apprentice agrees to perform satisfacto rily all work and learning assignments. The provisions of the
Apprenticeship Standards for the above occupation adopted by the program sponsor and approved by the Chief of the Division of
Apprenticeship Standards, are hereby made a part of this agreement. An official copy of the standards is on file in the headquarters of
the Division of Apprenticeship Standards. This apprentice agreement will continue in effect until the training is completed or otherwise
terminated in accordance with the standards.
The apprentice commences participation under these standards on the date of execution of this agreement by the Apprentice. The
signatory apprentice is credited with having ______ months toward completion of the term of apprenticeship. The apprentice is
expected to complete training on or about ____________________, 20____ , upon satisfactory completion of the total remaining
hours of on-the-job training and hours and/or units of related and supplemental instruction.
COUNTY OF RESIDENCE
O*Net code
40
SIGNATURE OF EMPLOYER OR ITS REPRESENT ATIVE TITLE
A
CCEPTED BY DAS
for unilateral programs only ]
This agreement is approved by
I, the undersigned apprentice understand and agree that this agreement is approved conditioned on obtaining an apprentice license
from the State Board of Barbering and Cosmetology, and if I fail to obtain this license within 90 days from the date of signing this
agreement this agreement will be cancelled.
I, the undersigned apprentice, hereby request that the Administrator of Apprenticeship terminate any other apprenticeship agreements
in which I am currently registered.
Executed this _______ day of _________________ , 20____ by _______________________________________________
AGREED TO BY THE EMPLOYER
SIGNATURE OF PARENT OR GU ARDIAN (IF APPRENTICE I S 16 OR 1 7)
AGREED TO AND APPROVED BY, FOR THE COM MITTEE
APPRENTICE: I, the undersigned apprentice, understand and agree that t here is a valid and reasonable necessity that those
academic records accumulated throughout related and supplemental instruction during my period of apprenticeship be made available
to the apprenticeship committee. Further, I agree to release to the apprenticeship committee any other academic records which I feel
may enhance my status as an apprentice.
A.
Gender
C. Number of Dependents (Do not count yourself)
Male
Female
0
None 4 Four
(Cal. Code of Regulations, Title 8, Ch. 2, Sec. 215 1 One 5 Five
B.
Ethnic or Race Derivation (Check only one
)
2 Two 6 Six of More
1
3 Three
(Voluntary)
2
D. Highest Year of Education Completed
1
8th Grade or less 6
1 Year of College
2
9th Grade 7
2 Years of College
3
10th Grade 8
3 Years of College
4
11th Grade 9
A
Asian Asian Indian
5
B Asian Bangladeshi
C
Asian Chinese (Cal. Labor Code, Ch. 4, div. 3, Sec. 3076.3)
D
Asian Cambodian
E.
6
Asian Filipino
0
None
E
Asian Hmong
1
Less Than 1 Year
I
Asian Indonesian
2
1 But Less Than 2 Years
J
Asian Japanese
3
2 But Less Than 3 Years
K
Asian Korean
4
3 But Less Than 4 Years
L
Asian Laotian
5
4 But Less Than 5 Years
M
Asian Malaysian
6
5 Years or More
P
Asian Pakistani
R
Asian Sri Lankan
(Voluntary)
T
Asian Taiwanese
F.
U
Asian Thai
Yes
No
V
Asian Vietnamese If yes, Please Enter:
F
Native Hawaiian Fijian Month and Year Entered ______________________
G
Native Hawaiian Guamanian Month and Year Separated ____________________
H
Native Hawaiian Hawaiian Total Months served on Active Duty _____________
S
Native Hawaiian Samoan
W
Native Hawaiian Tongan
4
7
(Cal. Labor Code, Ch. 4, div. 3, Sec. 151)
TO THE APPRENTICE: California Civil Code Sec. 1798.17 requires State agencies which collect personal information to indicate the
authority under which the data are requested. If personal information not specifically authorized by law is requested, individuals must be
informed that supplying the information is voluntary. It also provides that state agencies may change or modify records at the request of the
individual.
Questions C and E below are voluntary. All others are authorized by law, as indicated by the reference in each section. If the authorized
questions are not answered, the apprentice agreement cannot be accepted.
The Division hopes, through collection of this data, to improve the apprenticeship program both for those presently enrolled and for future
apprentices. Thank you.
CALIFORNIA APPRENTICE QUESTIONNAIRE
(USE INK OR BALLPOINT PEN)
WHITE (Not of Hispanic Origin) -- A person having origins in
any of the original peoples of Europe, North Africa or the Middle
East.
BLACK (Not of Hispanic Origin) -- A person having origins in
any of the Black racial groups of Africa.
Number of Years You Have Been Employed Full Time to Date
(Except for Military Service)
ASIAN OR PACIFIC ISLANDER -- A person having origins in
any of the original peoples of the Far East, Southeast Asia, the
Indian Subcontinent or the Pacific Islands. The area includes,
for example, China, Japan, Korea and Samoa.
AMERICAN INDIAN OR ALASKAN NATIVE -- A person having
origins in any of the original peoples of North America, and who
maintains cultural identification through tribal affiliation or
community recognition.
Have You Served on Active Duty (other than reserve status) in
the U. S. Armed Forces?
HISPANIC -- A person of Mexican, Puerto Rican, Cuban, South
Central American or other Spanish culture or origin, regardless
of race.
4 or more Years of
College
12th Grade (or GED
Certificate)
Apprentice's Signature _____________________________________
