Fillable Printable Apprentice Agreement - Massachusetts

Apprentice Agreement - Massachusetts

APPRENTICE AGREEMENT

Pursuant to the Standards of Apprenticeship adopted by the Sponsor and registered with the Massachusetts Division of Apprentice Standards,

the provisions of which are hereby made part of this Agreement, and in compliance with the Massachusetts Plan for Equal Employment in

Apprenticeship Standards, WITNE

SSETH: that the Agreement is entered into by the undersigned:

/ ________________________________________________________

(Name of Apprentice) (Address of Apprentice)

(Name of Program Sponsor) (Employer, JAC, JATC, Assoc. of Employers or Org. of Employers.)

OCCUPATION: ______________ TERM OF APPRENTICESHIP________________ HOURS.

DATE APPRENTICESHIP BEGINS: ____ _____ PROJECTED COMPLETION DATE: ______________________

CREDIT FOR PREVIOUS: OJT EXPERIENCE:_____________ RELATED TRAINING HOURS STARTING STEP #___ _____

GRADUATED SCALE OF WAGES IN (PERCENTAGES TO BE PAID THE APPRENTICE. PERCENTAGES ARE BASED ON JOURNEY PERSON

WAGES)

On projects where there is a prevailing rate set by law, the rate of pay shall comply with the wage rate or percentages stated on the wage

schedules issued by the Department of Labor Standards. The percentages below are to be used on all other jobs

PERIOD(s):__________________________

M inimum Journey person rate as of (Date) is $ per ho ur

____________ Hours/day ____________Hours/week Overtime Rate: _________________

The pa rties hereto ag ree t hat the terms stated on the reverse side of t his form are par t o f t his agreement. I hereby authorize

the Divisio n of Apprentice 6WDQGDUGV to request access to all my related training records directly from any school/training

progr

am I m

ay attend as part of my apprenticeship.

____________________________________________________________

(Signature of Apprentice) / (PLEASE SIGN IN BLUE INK)

_________________________________________________________________

(Signature of Program Sponsor) / (PLEASE SIGN IN BLUE INK)

(Signature Parent/Guardian, If Minor)

__________________________________________________________________

(Address of Program Sponsor)

__________________________________________________

(Signature of Union JAC, JATC) / (PLEASE SIGN IN BLUE INK)

Approved by the Division of Apprentice 6WDQGDUGV: _____________________________ Date: ________

Version: 10/15/2013

FOR OFFICE USE ONLY

The Commonwealth of Massachusetts

Department of Labor Standards

Division of Apprentice Standards

19 Staniford Street, 2

Floor, Boston, MA 02114

Compliance Officer Number:

__________

Sponsor Number____________________

APPRENTICE STATUS

DATE

Date Entered

Completed / Certificate

Suspended

Cancelled

Military Service

Deceased

Annual Fee: $35.00 for photo ID (please include one passport size photo)

Apprentice ID Number

The Program Sponsor and the Apprentice, by affixi ng their signatures in conformity wi th the terms and conditions provided herein, hereby agree to the

following:

The apprentic e program sponsor s hall ensure that the apprentice receives 150 hours per year of related instructio n in all subjects related to the

trade. Such instruction may be given in a classroom or through correspondence courses or other forms of self-study, but must be approved by the

Director. The s ponsor will not necessarily be respo nsible for paying the co s t of the related instruction or any boo ks , other writte n mater ials , o r su p plies

necessary for such instruction. If how ever, the apprentice is to be responsible for all or any portion of such costs it must be specified below.

COST TO BE INCURRED BY APPRENTICE: [please have apprentice initial all item(s) that apply]

TUITION_________ BOOKS_________ TOOLS ________ NONE_________

Prior Employment Hourly Pay Rate:

____________ Received Copy of DAS Apprentice Handbook __________

Apprentice

Sponsor

The Program Sponsor agrees to abide by all applicable provisions of the Massachusetts Plan for

Equal Employment in Apprenticeship

Standards

The Apprentice agrees to be diligent and faithful in learning the stated occupation including

attendance of 150 hrs. in related instruction classes, for each year of apprenticeship.

The first 25% or one year of employment whichever is less shall be a probationary period during

which time this Agreement may be canceled by either party with notification to the other and to the

Massachusetts Division of Apprentice

Standards.

This agreement must be approved by and filed with the Division of Apprentice Standards before the

apprentice starts work and co

pies must be received by the sponsor.

The Deputy Director of A

pprentice Standards may cancel the agreement subject to hearing upon

application by any party.

The parties recognize that prevailing wage rates for public works projects are set by the Department

of Labor Standards, and that the wages listed in these program standards do not supersede or

replace the wage rates determined by the Department of Labor Standards.

SS#____________________ (E-Mail Address) ___ (Date of Birth) (Phone)__________________

Completion of part of the boxed section is voluntary. The information will remain confidential and will be used for aggregate statistical

data only.

TO BE COMPLETED BY APPRENTICE (Please check, circle or fill in items as appropriate)

SEX

M___

F___

Ethnic Group:

1. White (Caucasians) other than Hispanic_____ 2. Black_____

3. American Indian or Alaskan Native_____

4. Asian or Pacific Islander_____

5. Hispanic including persons of Cuban, Mexican, Puerto Rican, Central or South

American, or other Spanish culture or origin, regardless of race.

______

6. Other____

VETERAN

1. Vietnam Era Veteran__

2. Other Veteran__

3. Non Veteran__

DISABLED

YES__

NO___

Check highest grade of school completed 12 GED Other _______

COLLEGE 13 14 15 16 17 18

AFFIDAVIT BY APPRENTICE APPLICANT

Signature of Applicant: ____________________________ Date: ___________________

State of Massachusetts, County of__________________________

____________________________ being duly sworn deposes and says that he/she is the person referred to in the forgoing

application; that the statements herein contained are true in every respect; and that he/she read and understands this affidavit.

Sworn and subscribed by me this _______________________ day of ________________________

____________________________ ______________________

(DAS Rep or Notary Public) Signature (DAS Rep or Notary Public) Print Name

My Commission Expires: _________________________

RETURN APPLICATION TO:

Division of Apprentice Standards, 19 Staniford Street, 2nd Floor, Boston, MA 02114