Fillable Printable Apprenticeship and Training Agreement Form - Delaware

Apprenticeship and Training Agreement Form - Delaware

STATE OF DELAWARE

Department of Labor

Division of Industrial Affairs

Apprenticeshi p & Training Section

225 Corporate Blvd. Suites 104

Newark DE 19702

(302)451-3423(P) (302)368-6604(F)

Apprentice ID:

Sponsor ID:

NAME OF APPRENTICE : (Last, First, M.I.)

NAME OF THE PROGRAM SPONSOR :

ADDRESS OF THE APPRENTICE : (NO. & STREET)

ADDRESS OF THE SPONSOR : (NO. & STREET)

(CITY, STATE, Z IP CODE, COUNTY)

SOCIAL SECURITY NO:

APPRENTICE PHONE #

SPONSOR PHONE #

RACE/ETHNIC GROUP: (Check one)

( ) BLACK or AFRICAN AMERICAN ( ) HISPANIC or LATINO

( ) AMERICAN INDIAN or ALASKA NATIVE ( ) ASIAN ( ) WHITE

( ) NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER ( ) OTHER

SEX:

( ) M

( ) F

DATE OF BIRTH :

AMERICAN CITIZEN :

( ) YES

( ) NO

VETERAN :

( ) YES

( ) NO

HAVE YOU EVER BEEN AN APPRENTICE?

( ) YES

( ) NO

SCHOOL AND LOCATION :

JOURNEYPERSON RATE :

STARTING PAY

RATE :

APPRENTICE PROBATIONARY PERIOD :

TRADE:

CREDIT FOR PREVIOUS

EXPERIENCE :

APPRENTICESHIP

TERM :

TERM REMAINING :

Wage Rate to be paid the Apprentice each period of apprenticeship: (Period may be expressed in hours, months, or years; rate shall be

expressed in percent of journe yman's w age)

PERIODS: RATES: PERIODS: RATES:

1ST 1 - 1000 HRS

% 6TH 5001- 6000 HRS %

2ND 1001- 2000 HRS

% 7TH 6001- 7000 HRS %

3RD 2001- 3000 HRS

% 8TH 7001- 8000 HRS %

4TH 3001- 4000 HRS

% 9TH 8000- 9000 HRS %

5TH 4001- 5000 HRS

% 10TH 9000- 10000 HRS %

SIGNATURE OF THE APPRENTICE :

DATE:

SIGN ATURE OF AUTHORIZED COMPANY OFFICIAL :

DATE:

SIGNATURE OF AUTHORIZED STATE OFFICI AL :

DATE APPRENTICESHIP BEGINS:

WORKSITE

TRAINING COMPLETION/TERMINATION (PLEASE SIGN AT BOTTOM OF THE PAGE)

CHECK

ONE:

(

) COMPLETED WORKSITE TRAINING ( ) LAYOFF (LACK OF WORK) ( ) PROGRAM TERMINATION ( ) QUIT ( ) TERMINATED FOR CAUSE (EXPLAIN IN COMMENTS)

COMPLETION

OR TERMINATION DATE:

COMMENTS:

ORIGINAL MUST BE SENT VIA MAIL