Fillable Printable Apprentice Agreement - Massachusetts
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, andin 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 OFAPPRENTICESHIP________________HOURS.
DATE APPRENTICESHIP BEGINS: ____ _____ PROJECTED COMPLETION DATE: ______________________
CREDIT FOR PREVIOUS: OJT EXPERIENCE:_____________RELATEDTRAINING HOURSSTARTING STEP #________
GRADUATED SCALE OF WAGES IN (PERCENTAGES TO BE PAID THE APPRENTICE. PERCENTAGESARE 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 LaborStandards. The percentages below are to be used on all other jobs
PERIOD(s):__________________________
1
st
3
rd
5
th
7
th
9
th
2
nd
4
th
6
th
8
th
10
th
M inimum Journey person rate as of (Date)is $per ho ur
____________Hours/day ____________Hours/weekOvertime 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 ApprenticeStandards
19 Staniford Street, 2
nd
Floor, Boston, MA02114
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 BYAPPRENTICE:[please have apprentice initial all item(s) that apply]
TUITION_________BOOKS_________TOOLS________NONE_________
Prior Employment Hourly PayRate:
____________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 inApprenticeship
Standards
.
TheApprentice 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 yearof 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 ApprenticeStandards before the
apprentice starts work and co
pies must be received by thesponsor.
TheDeputyDirector of A
pprentice Standardsmay 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 LaborStandards, and that the wages listed in these program standards do not supersede or
replace the wage rates determined by the Department of LaborStandards.
SS#____________________ (E-Mail Address) ___ (Date of Birth)(Phone)__________________
Completionof part of the boxedsection 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 Indianor Alaskan Native_____
4. Asian or Pacific Islander_____
5. Hispanicincluding personsof 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 gradeof school completed 12GED Other_______
COLLEGE 13 14 15 16 17 18
AFFIDAVIT BY APPRENTICE APPLICANT
Signature ofApplicant:____________________________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 NotaryPublic) Signature(DAS Rep or Notary Public) Print Name
MyCommission Expires:_________________________
RETURN APPLICATION TO:
Division of Apprentice Standards, 19 Staniford Street, 2nd Floor, Boston, MA 02114
