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Apprenticeship Program Application Documents –

Expansion Industries

Request for approval of registered apprenticeship program(s) by:

Massachusetts Division of Apprentice Standards

19 Staniford St

Boston, MA 02114

(617) 626-5409

Program Status:

Occupation

Date

Approved

Title of DAS

Approving

Authority

Name of DAS

Approving

Authority

Signature

[Official use only]

[Insert sponsor name]

INTRODUCTION

Congratulations on taking the first step towards becoming a registered apprenticeship program

sponsor. Apprenticeship is an innovative work-based learning model that helps employers

cultivate skilled talent and helps jobseekers access high-quality learning and employment

opportunities. Please consider this document a resource while completing this application.

However, if at any time you have questions or require assistance, please contact

apprenticeship@mass.gov

This application is designed for “Expansion Industries”, namely advanced manufacturing,

healthcare, and technology. This application can also be used for other industries that wish to

start apprenticeship programs that do not fall in the Building Trades category. Building Trades

applicants should use Apprenticeship Program Standards and Application – Building Trades,

located in this document.

This document is an apprenticeship program standard, as well as an application for

sponsorship. With DAS approval, it will govern how a sponsor’s apprenticeship program works

and serves as the standards by which the program operates.

Apprenticeships are governed by federal law (29 U.S.C 50), federal regulations (29 CFR Part 29

& 30), state law (Chapter 23, Section 11E-W) and regulations (454 CMR 26.00).These standards

conform to all of the above and are read together with federal and state laws and rules. The

Massachusetts Division of Apprentice Standards (DAS) is the regulatory body for approving,

administering, and enforcing apprenticeship standards in Massachusetts.

With the submission of this application, a registered apprentice program sponsor declares their

intent and policy to establish a system of registered apprenticeship, education and training.

The sponsor recognizes DAS authority to regulate an approved program. Any proposed

additions or changes to a registered apprenticeship program or its standards must be

submitted to DAS for consideration and approval before proposed additions are implemented

by a sponsor. Changes are binding on apprentices, sponsors, training providers, and anyone

else working under an agreement governed by these standards. Sponsors may have to maintain

additional information as supplemental to these standards. When a standard is changed,

sponsors are required to notify apprentices and employers. If changes in federal or state law

make any part of these standards illegal, the remaining parts are still valid and remain in force.

Only the part made illegal by changes in law is invalid.

The “fillable” fields in these standards are indicated with blue bars. These fields are specific to

the individual program standards and may be modified by a sponsor. All other sections of

these standards are required and may only be modified by DAS. See the appendix of this

document for the definitions necessary for use with these standards.

[Insert sponsor name]

Sponsors and any entity proposing to employ an apprentice in this program must enter into an

agreement (see Appendix) prior to employment and enrollment of apprentices. Each

apprentice will complete an Apprentice Agreement. Sponsors using in-house training providers

must fill out the Proctor and Curriculum Certification Application in the Appendix.

If an approved sponsor would like to add additional occupations at a later date, a new

application is not necessary. Instead, complete the “Add Occupation” form and include the

training outline and work process specific to the new occupation.

Table of Contents: Application Documents

Part 1. Program Sponsor Registration

To be completed for program and sponsor approval

I. Sponsor Background Information…………………………………………....…[4]

II. Location of Business Operations………………………..………..…………..…[5]

III. Certificate of Good Standing………………………………………………..….….[6]

IV. Equal Opportunity Employment Pledge………………………………....….[7]

Part 2. Apprenticeship Program Model

To be completed for program and sponsor approval

I. Apprenticeship Program Model…………………………………………..….…[8]

II. Sponsor Responsibilities and Program Management……….…….…[14]

Part 3. Program Launch Documents

To be completed prior to apprentice start date

I. Related Technical Instruction............................................[20]

II. Proctor Certification Form………………………………………………………....[22]

III. Apprentice Acceptance Agreement……….…………………………....…......[24]

Part 4. Additional Document

To be completed as necessary

I. Add Occupation Form……….…..…………………………………..…..……........[28]

The following documents must be modified and re-submitted if program components change:

• Contact information

• Apprenticeship Program Model (to reflect changes to work process OR wage rates)

• Proctor Certification Form

• Related Technical Instruction Form

Each of the following Parts contains a “Definitions” box at the beginning of the section. Please

review this section prior to filling out the form. A full list of definitions is compiled in the

appendix.

[Insert sponsor name]

Part I: Program Sponsor Registration

DEFINITIONS

Sponsor: any person, association, committee, or organization operating an apprenticeship program and

in whose name the program is (or is to be) registered or approved. A program sponsor may be an

employer or an intermediary organization.

Employer: any person or organization employing an apprentice, whether or not such person or

organization is a registered sponsor and party to an apprentice agreement with the apprentice. The

employer is responsible for facilitating the on-the-job training component of the apprenticeship.

I. SPONSOR BACKGROUND INFORMATION

Sponsor name:

Address:

Type of entity:

☐

Corporation

☐

Partnership

☐

Sole Proprietorship

EIN Number:

Year sponsor went into business:

List all previous names of sponsor:

If none, write ‘NA’

Name of Program Director:

Note: Program Director is responsible for

overseeing all aspects of apprenticeship programs

Mailing address: (if different from above)

Work phone:

Cell phone:

Email address:

Certifying Official: Complete if implementing VA

education benefits for veteran employees

(For more information, review VA benefits

employer handbook)

Work phone:

Email address:

[Insert sponsor name]

II. LOCATION OF BUSINESS OPERATIONS

In order to be approved by the Division of Apprentice Standards, the sponsor’s apprenticeship program

must be primarily located in Massachusetts. Responses to the following questions will be used to make

that determination.

1. Is your primary operating facility in Massachusetts?

☐ Yes ☐ No

2. Will the administration of the proposed apprenticeship program be conducted in

Massachusetts?

☐ Yes ☐ No

3. Will all documents and records concerning the proposed apprenticeship program be located in

Massachusetts?

☐ Yes ☐ No

4. Will the majority of work performed by apprentices be in Massachusetts?

☐ Yes ☐ No

[Insert sponsor name]

III. CERTIFICATE OF GOOD STANDING

Within the last five years, has the sponsor, or any affiliated entity

been the subject of the following?

Litigation

1. A judgment or conviction for any business-related conduct constituting a crime under state or

federal law?

☐ Yes ☐ No

2. Any pending litigation or administrative proceedings with or before any state or federal

agencies?

☐ Yes ☐ No

3. A grant of immunity for any business-related conduct constituting a crime under state or

federal law?

☐ Yes ☐ No

4. In the last year, have you been a party to any civil or criminal enforcement action by any

Massachusetts State Agency?

☐ Yes ☐ No

Safety or Environmental Violations

1. Any OSHA violation categorized as serious, willful, repeat, failure to abate, or as retaliating

against an employee for filing a safety or health complaint?

☐ Yes ☐ No

Consumer Protection Violations

1. Any determination by the Massachusetts Department of Consumer Protection related to

violations of a state occupational licensing statute or regulation, or pending enforcement

proceeding regarding the same?

☐ Yes ☐ No

2. A consent order entered into with the Massachusetts Department of Consumer Protection or

any other state or federal government agency?

☐ Yes ☐ No

Certifications

1. The a

pplicant is

current with all obligations related to Unemployment Insurance payments. The

Division will verify compliance with the Department of Unemployment Assistance.

☐ Yes ☐ No

2. The applicant is in compliance with worker’s compensation coverage requirements. The Division

will verify compliance with the Department of Industrial Accidents.

☐ Yes ☐ No

An affiliated entity is a branch, unit or subsidiary of a larger company, the regional or national organization, a company effectively controlled

by another or associated with others under common ownership or control.

[Insert sponsor name]

I. IV. EQUAL EMPLOYMENT OPPORTUNITY PLEDGE (EEO)

For sponsors with five or more apprentices, affirmative action information will be kept by the sponsor

and made available for annual review by the Division. These policies and procedures apply to the

recruitment and selection of apprentices, and to all conditions of employment and training during

apprenticeship.

The purpose of this plan is to promote equality of opportunity in apprenticeship by prohibiting

discrimination based on race, color, religious creed, national origin, sex, sexual orientation, genetic

information, disability or ancestry in apprenticeship programs, by requiring affirmative action to provide

equal opportunity in such apprenticeship programs, and by coordinating this part with other equal

opportunity programs.

1. Do you expect your program to have 5 or more apprentices?

☐ Yes ☐ No

Note: If ‘No’, please move on to the next section.

2. will not discriminate against apprenticeship applicants or apprentices based on

race, color,religion, national

origin, sex (including pregnancy and gender identity), sexual orientation,

genetic information, or because they are an individual with a disability or a person 40 years old or older.

will take affirmative action to provide equal opportunity in apprenticeship and will

operate the apprenticeship program as required under Title 29 of the code of Federal Regulations Part

[Insert sponsor name]

Initial here

Part II: Apprenticeship Program Model

Sponsor name:

Occupation name:

Date submitted:

Select one:

☐

Original application

☐

Update to program model

If update, indicate

which section:

☐ Work Process ☐ Ratio ☐ Apprentice Wage and Wage Progression

I. APPRENTICESHIP PROGRAM MODEL

The initial application must be submitted with at least one program model. To add another occupation,

use the ‘Add an Occupation’ documents provided in the Appendix of this document. To make updates or

modifications to the apprenticeship program model or wage schedule please resubmit the relevant

portions of this form.

A. Work Process

A work process outlines the skills and competencies an apprentice must be proficient in to become a

fully-qualified employee for the occupation. The apprentice shall receive training and work experience

in order to learn and master these competencies.

Sample work processes already developed by sponsors can be found here

. Rather than starting a work

process from scratch, we strongly recommend you review any available options on the link. To build a

work process, the sponsor can also use the job description as a starting place. If you need assistance

developing a work process, please contact

apprenticeship@mass.gov.

DEFINITIONS

Work process: Skills and competencies an apprentice must be proficient in to become a fully-qualified

employee for the occupation.

Occupation name: A set of jobs whose main tasks and duties are characterized by a high degree of

similarity (International Labor Office). An occupation name is generic. This is distinct from a job title,

which is often specific to an individual employer.

ONET Code: An ONET code is also a SOC (Standard Occupational Classification Code). It is used by

federal agencies to classify job types.

Term of apprenticeship: The method by which an apprentice is judged to have completed the program

and obtained the required competencies. The Term may be measured through:

• Time-based model: The completion of on-the-job learning (at least ~2000 hours). Models must list

number of hours required for each competency in the RTI/OJT section of the work process.

[Insert sponsor name]

• Competency-based model: The attainment of competency as demonstrated via evaluation methods

e.g. completion of an exam. Models must show how competency will be evaluated under the

RTI/OJT section of the work process.

• Hybrid model: A blend of the time-based and competency-based approaches. Models must show

how competency will be demonstrated through a combination of hours and evaluation.

Job Function: Main job functions or duties someone in this occupation would be expected to perform

Competency: A set of tasks or skills associated with a particular job function

Related Technical Instruction (RTI): a systematic form of instruction that teaches the apprentice

technical or academic competencies that apply to the job, typically provided in a classroom or online.

For full definition, see Appendix.

On the Job Training (OJT): hands-on training from an experienced journey-level mentor at the job site.

On the job training focuses on the skills and knowledge an apprentice must learn during the program to

be fully proficient on the job.

Model requirements

• An apprenticeship must include at least 2000 hours of On the Job Training and 150 hours of

Related Technical Instruction, or approximately one year in length.

• There are no limits or requirements to the number of job functions or competencies associated

with a given apprenticeship model. The template is editable.

• No more than 50% of the program will be accepted as credit for previous experience or training.

• For the purposes of this work process format, list either the number of hours, standard (e.g.

completion of exam), or both that will be required to fulfill a specific competency.

[Insert sponsor name]

Work Process Template

Occupation Name:

ONET Code:

Term of Apprenticeship: ☐ Time based ☐ Competency based ☐ Hybrid

Job Function 1:

Competencies

RTI

OJT

Job Function 2:

Competencies

RTI

OJT

Job Function 3:

Competencies

RTI

OJT

Job Function 4:

Competencies

RTI

OJT

Job Function 5:

Competencies

RTI

OJT

Job Function 6:

Competencies

RTI

OJT

Total Hours

[Insert sponsor name]

B. Ratio of Apprentices to Journey-Level Mentor

The apprentice will be under the general supervision of a journey-level mentor with whom the

apprentice will work and receive on-the-job training. The journey-level mentor is responsible for

ensuring that the apprentice receives the work experience outlined in this document in order to

promote the safety, health and education of the apprentice. Sponsors ensure apprentices are

supervised by competent, qualified journey-level mentors.

DEFINITIONS

Journey-level: level of mastery that is equal to or greater than the term of an apprenticeship.

Journey-level mentor: a worker who has attained a level of skill, abilities and competencies recognized

within an industry as having mastered the skills, abilities, and competencies required for the occupation.

Practical experience must be equal to or greater than the term of apprenticeship. Often a

supervisor/manager, lead staff for a unit, etc.

1. Ratio of apprentices to journey-level mentors:

Apprentice : Journey-level mentor

Describe rationale for ratio here:

[Insert sponsor name]

Insert #

C. Apprentice Wages and Wage Progression

DEFINITIONS

Journey-level: level of mastery that is equal to or greater than the term of an apprenticeship.

Journey-level wage: the market wage paid to a fully-qualified worker. This is the minimum wage the

apprentice will be paid upon completion of the apprenticeship. It is not necessarily the wage the

apprentice’s journey-level mentor is making.

Step: wage increase experienced by the apprentice throughout the program. Each apprentice must have

at least one step increase during the term of the apprenticeship.

The following requirements apply to apprentice wages and wage progression:

• Apprentices must be paid at least minimum wage prescribed by applicable state or federal law,

unless a higher wage is required by other applicable laws or collective bargaining agreements.

• Apprentices must be paid according to a progressively increasing wage scale. This wage scale

demonstrates an increase in wage as the apprentice increases his or her competency.

• The wage scale must be expressed as a percentage of the minimum journey-level wage. This is a

federal requirement.

• The wage steps must not average less than 50% of the journey-level wage over the program’s

duration.

• All percentages and wages are expressed as the minimum wage the apprentice must earn at

that step or at completion of the program. The apprentice may earn above the minimum at each

step.

1. Journey-level wage. This is the minimum wage that will be paid to the apprentice at the

completion of the apprenticeship, and should be equivalent to the market rate for a fully

qualified employee in this occupation.

Journey-level wage

[Insert sponsor name]

0 (beginning wage)

[Insert x-xx hours or competency

requirement for progression to next step,

i.e. completion of exam]

[Insert % of journey-level

wage]

1 (required)

2 (if applicable)

3 (if applicable)

Journey-level 100%

Sample journey-level wage and wage progression schedule

Journey-level wage $40/hour

Step Hour range or competency requirements

Percentage of journey-

level wage

0 (beginning wage) 0-1000 60%

1 (required) 1000-2000 80%

2 (if applicable)

3 (if applicable)

Journey-level 100%

Note: this sample program averages 70% of a journey-level mentor’s wage over the course of the

program, and thus meets the requirement that the average of wages are at least 50% of the

journey-level wage.

during the term of the apprenticeship. If the program has more steps than listed, this should be

added as an attachment to this form. The percentage rate in the last column should be

expressed as a percentage of the journey-level wage rate, and is the minimum the apprentice

must be paid at that point in his or her apprenticeship.

Step Hour range or competency requirements

Percentage of journey-

level wage

2. Wage progression schedule. Every apprentice must have at least one step (wage) increase

[Insert sponsor name]

II. SPONSOR RESPONSIBILITIES AND PROGRAM MANAGEMENT

The following is an overview of the requirements associated with administering an

apprenticeship program. The sponsor is the policymaking and administrative body responsible

for the operation and success of this apprenticeship program.

A. Administrative Procedures

The sponsor may include in this section a summary and explanation of administrative actions

performed at the request or on the behalf of the apprentice. Such actions may include but are

not limited to:

1. Voluntary Suspension: A temporary interruption in progress of an individual's apprenticeship

agreement at the request of the apprentice and granted by the sponsor.

2. Advanced Standing or Credit: The sponsor may grant credit or advanced standing to an

apprentice for hands-on training or related instruction obtained in previous apprentice

programs, employment or education. A sponsor’s policy must comply with the following:

• Such previous training or experience must be documented and comply M.G.L. c 23, §§

11E through 11W and 454 CMR 26.00

• Step increases in pay shall be commensurate with the credit given to the apprentice

• No more than 50% of the program will be accepted as credit for previous experience

or training

B. Disciplinary Procedure

The sponsor may include in this section requirements and expectations of the apprentices and an

explanation of disciplinary actions imposed for noncompliance. The sponsor must adopt the

following disciplinary procedures:

1. Extension: The sponsor may preclude an apprentice from obtaining the next step or extend

the apprenticeship when the apprentice does not achieve the level of competency necessary

for advancement or program completion. In such a case, the sponsor must comply with the

following:

• The apprentice’s periodic evaluation shall describe the reasons for such action

• The apprentice shall be notified of and initial the evaluation

• The evaluation shall be forwarded to the Division with a request for an extension of

the apprentice’s agreement

• In no event shall the term of the apprenticeship be extended more than two six-

month periods over the term of the apprenticeship, except on a case-by-case basis

• The apprentice may be required to renew their apprentice card and pay an annual $35

fee.

[Insert sponsor name]

2. Cancellation: Refers to the termination of an apprenticeship agreement at the request of the

apprentice, supervisor, or sponsor. Within 30 calendar days of an apprentice’s cancellation

of the program, the sponsor must send written notification thereof to the Division.

3. Sponsor: please attach your employee handbook or disciplinary procedures for apprentices

or the employer handbook(s) if you are not the sponsor OR document your disciplinary

procedures below. Check one:

I have attached an employee handbook that describes disciplinary procedures. ☐

I have documented disciplinary procedures below. ☐

[Insert sponsor name]

C. Apprentice Complaint Procedures

The sponsor must adopt the following procedures:

1. The sponsor shall establish a procedure to receive, investigate, and resolve complaints and

concerns raised by the apprentices relative to the apprentice program.

2. To the extent possible, confidentiality shall be maintained of the information provided to the

sponsor concerning matters raised by apprentices.

D. Program Operations

The sponsor will record and maintain records pertaining to the administration of the

apprenticeship program – including the apprentice’s work experience and related training

instruction – and make them available for examination by Division upon request.

Sponsors shall submit required forms/reports through assigned state compliance officers.

1. The following is a listing of forms/reports for the administration of apprenticeship programs

and the time-frames in which they must be submitted:

• Apprenticeship Agreements (within first 30 days of employment)

• Employer Acceptance Agreement (as necessary, in Appendix)

• Add Occupation (as necessary, in Appendix)

• Related Technical Instruction (RTI) Hours Reports (annually)

• On-the-Job Work Hours Report (annually)

• Apprentice Evaluations (as necessary – this can be a standard evaluation already in

use at employer, or DAS can provide a form if no such evaluation exists)

2. These standards of Apprenticeship may be amended by the sponsor provided such

amendments are approved by the Massachusetts Division of Apprentice Standards. A copy

of all changes shall be furnished to each apprentice.

[Insert sponsor name]

E. Management of Apprentices

1. Each apprentice (and, if under 18 years of age, the parent or guardian) will sign an

apprenticeship agreement with the sponsor, who will then register the agreement with the

Division before the apprentice attends RTI classes, or within the first 30 days of employment

as an apprentice. The apprentice must be employed and trained in an Apprenticeable

Occupation as defined in 454 CMR 26.02 and under these program Standards.

2. Every apprentice agreement entered into under these Standards shall contain a clause

making the standards a part of the apprentice agreement with the same effect as if

expressly written therein.

3. The sponsor shall provide the apprentice a copy of the program Standards (as outlined in

this document) and an opportunity to read them before any signature is affixed thereof.

Apprentices shall also receive a copy of the DAS Apprentice Handbook, as verified by

initialing the appropriate location on the apprentice agreement.

4. The apprentice shall not be less than 16 years of age. The employment of apprentices

between the ages of 16 and 18 shall comply with all Massachusetts and Federal child labor

laws.

5. The sponsor must notify the Division within 30 days of all requests for modification to

apprentice agreements, which may include:

• Certificate of Completion (separate form)

• Extension (separate form)

• Cancellation (separate form)

• Employee Exit Interview Questionnaire (separate form)

• Corrections

• Reinstatement

• Training agent cancellation

• Additional Credit

• Step upgrades

• Other (i.e. name changes, address)

6. The sponsor shall periodically review and evaluate apprentices before advancement to the

apprentice's next wage progression period.

7. The apprentice will be provided no less than full-time employment in the relevant

occupation.

• The first 25% of the apprentice hours worked shall be a probationary period. During

this probationary period the apprentice agreement may be canceled by either party

by notifying the other. The Division shall be notified of all such cancellations within 30

days.

[Insert sponsor name]

• The employer intends and expects to give the apprentice continuous employment and

will use its best efforts to keep the apprentice employed during the full term of

apprenticeship. If any apprentice is temporarily released due to business conditions,

that apprentice shall be given the opportunity to be reinstated before any additional

apprentice is employed in the same occupation.

• To permit the flexibility necessary to normal shop production hours, the work

experiences need not be in the precise order as listed, nor do the scheduled hours on

any operation need to be continuous.

8. Upon successful completion of the apprentice’s program, the apprentice program sponsor

shall recommend to the Division that a State Certification be awarded.

F. Completion of Standards

These standards shall be submitted to the Massachusetts Division of Apprentice

Standards for approval and will become effective upon the date of approval.

understands that there is a one year probationary period for this program during

which time the Division will monitor this program to determine compliance with the

policies and regulations of the Division. The probationary period may be extended if the

Director determines there is just cause.

I have read the enclosed material and the Apprentice Standards Regulations, and I

understand my responsibilities relative to the directives contained therein

Printed Name of Program Sponsor

Signature of Program Sponsor

[Insert sponsor name]

Initial here

Part III: Program Launch Documents

Related Technical Instruction Form

Proctor Certification Form

Apprentice Agreement

[Insert sponsor name]

Related Technical Instruction Form (RTI)

The following form must be submitted once a training provider has been selected for the program, and

prior to the apprentice start date, or at any time there is a new training provider for the established

occupation.

A. Sponsor Requirements

The apprentice sponsor shall ensure that the apprentice receives 150 hours per year of related

instruction, depending on the occupation. Such instruction may be given in a classroom, through

correspondence courses or other forms of self-study and is subject to DAS approval.

The sponsor may choose (but is not required) to cover the cost of related instruction or any materials

necessary for such instruction. If the apprentice is to be responsible for all or any portion of such

costs, the apprentice agreement must contain an explicit statement to that effect; otherwise, the

sponsor is responsible.

The apprentice shall be trained in safe and healthful work practices and shall work only in

environments that comply with all applicable Massachusetts and Federal occupational safety and

health standards.

1. Indicate below the method of related instruction (Select all that apply).

☐ Accredited public post-secondary institution (i.e. community college, state university)

☐ Accredited private post-secondary institution

☐ Private, industry-recognized training provider

☐ In-house training provider, provided by employer (fill out Proctor Certification)

☐ Other:

2. Training will be provided: ☐Online ☐In classroom ☐Hybrid online/in classroom

3. RTI hours per year:

By the signature placed below, the program sponsor agrees to provide the prescribed RTI for each

registered apprenticeship and assures that:

1. The RTI content and delivery method is and remains reasonably consistent with the latest

occupational practices, improvements, and technical advances.

2. The RTI is coordinated with the on-the-job work experience.

3. The RTI is provided in safe and healthful work practices in compliance with DAS and

applicable federal and state regulations.

Printed Name of Program Sponsor

Signature of Program Sponsor

[Insert sponsor name]

B. RTI Training Provider Information – All Institutions

If your related technical instruction will be provided by an institution in Massachusetts (i.e. not in-

house), please fill out the section below.

Occupation Title:

Total RTI

Hours:

Training Provider

Organization Name:

Please attach a letter from the training provider organization that includes the following

information:

• Name of training institution

• Number of hours for each course

• Schedule of courses (days of week and hours of instruction)

• Location of courses (name and address of institution)

The letter should be signed by either the head of the relevant department or by a member of

the senior leadership team (i.e. Chancellor, Provost, President, etc.)

C. RTI Training Provider Information – Non-Accredited Institutions OR In-House Training

If your training provider is not provided by an accredited Massachusetts institution OR is

provided in-house, you must submit proposed curriculum and a Proctor Certification form

(next page).

Check all that apply:

• A Proctor Certification Form is attached. ☐

• Curriculum is attached. ☐

[Insert sponsor name]

Instructor / Proctor Certification Application

453 CMR 7.04(2 ) requires that every apprenticeship instructor a) meet the Commonwealth’s Department of

Education’s requirements for a vocational technical instructor, or be a subject matter expert, which is an

individual, such as a journey-level mentor, who is recognized within an industry as having expertise in an

specific occupation and b) has training in teaching techniques and adult learning styles.

Requests for certification must be submitted to: apprenticeship@mass.gov

OR 19 Staniford Street, 2

floor

Boston Ma 02114

A. General Information

1. Date Submitted:

Date Received: (offi ce use only)

2. Name of Sponsor Submitting This Application:

3. Name of Instructor to be Certified:

4. Hire date of Instructor to be Certified:

5. Occupation For Which Instruction Will Be Provided:

B. Instructor’s Educational Preparation (Describe the instructor’s academic history and achievements.)

1. Has instructor had at least 10 hrs. of instruction in Teaching Techniques? Yes ☐ N o ☐ If no, how many?

2. Did the instruction confer competency in these specific areas:

1) Yes ☐ No ☐ Instructor is able to plan learning environment that meets the needs of learners.

2) Yes ☐ No ☐ Instructor is able to select learning materials that support a learning plan.

3) Yes

☐

Ins tructor is able to create teaching plans.

2a. Where was the instruction received? 2b. Date(s) of Instruction:

2c. Course name(s):

3. Has instructor had at least 10 hrs. of i nstruction in Adult Learning Styles? Yes No If no, how many?

3a. Did the i nstruction confer competency i n these specific areas:

1) Yes ☐ No ☐ Instructor is able to analyze models of learning.

2) Yes ☐ No ☐ Instructor is able to apply a model of learning to teaching practice.

3b. Where was the instruction received?

3c. Date(s) of Instruction 3d. Course name(s):

C. Instructor’s Occupational Experience (Des cribe instructor’s fi el d experi ence or work history, use reverse if

needed.)

Instructors must have at least six years’ experience in the specific occupation.

1. Does instructor have at least six years (12,000 hrs.) occupational experience?

Yes

☐

Occupation & Position Held

2. Employer Name and Address

Begin Date

End Date

[Insert sponsor name]

Signature of Apprenticeship Program Director (Sponsor)

Date

[Insert sponsor name]

Apprentice Agreement - Expansion Industries

This apprenticeship agreement applies only to non-prevailing rate apprenticeship programs.

The Apprentice Agreement formalizes the relationship between the Registered Apprentice and the

Program Sponsor. 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, Witnesseth: that the Agreement is entered into by the undersigned:

Apprentice and Program Information

Wage Scale and Hours

The graduated scale of wages must reflect the wage scale in the program sponsor’s application. This

wage progression should reflect the minimum amount the apprentice can expect to make at each step

Journey-level wage

Step Hour range or competency requirements

Percentage of journey-

level wage

0 (beginning wage)

1 (required)

2 (if applicable)

3 (if applicable)

Journey-level

100%

Overtime rate

Hours employed/day

Days employed/week

The Program Sponsor and the Apprentice, by affixing their signatures, agree to the following:

This should be the occupation name listed in the sponsor’s Apprenticeship Program Model.

Name of apprenti ce:

Apprentice’s empl oyer:

Address of apprentice:

Job titl e:

Program sponsor:

Occupation

Apprenticeship start date:

Length of apprenticeship:

Proj ected apprenticeship

completion date:

Credi t for prior experience,

if applicable:

[Insert sponsor name]

• The terms stated on the reverse side of this form are part of this agreement.

• The Division of Apprentice Standards may access to all related training and instruction records

directly from any school/training the apprentice attends as part of apprenticeship.

• The apprentice program sponsor shall ensure that the apprentice receives a minimum of 150

hours per year of related instruction in all subjects related to the occupation.

• The sponsor will not necessarily be responsible for paying the cost of the related instruction or

any books, other written materials, or supplies necessary for such instruction. If however, 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 ________ Equipment

________ Books ________ None

Apprentice Sponsor

________ ________ The apprentice will be employed for a minimum of 2,000 hours of as an

apprentice, consistent with training requirements established by industry practice, in the occupation to

which he/she is apprenticed.

________ ________ 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 faithful in learning the stated occupation

including mandatory attendance in 150 hours of related instruction for each year of Apprenticeship.

________ ________ The first 1000 hours or six months of employment 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 within 30 days after the apprentice’s start date and copies must be returned to

sponsor.

________ ________ The Director of Apprentice Standards may cancel the agreement subject to

hearing upon application by any party.

________ ________ Apprentice has the legal right to work in the United States.

________ ________ Apprentice has received the DAS Apprentice handbook.

_____________________________

Signature of Apprentice

_____________________________

Signature of Program Sponsor

_____________________________

Signature of Parent/Guardian, if minor

Initial here

[Insert sponsor name]

Mandatory Demographic Information – to be completed by Apprentice

Social Security Number

Date of Birth

Phone

Gender

Veteran

Highest level of school

completed

Indicate any special

accommodations you

may require:

Ethnicity (select all that

apply)

☐White ☐Black or African American ☐Hispanic or Latino ☐Asian or

Pacific Islander ☐American Indian or Alaskan Native

[Click for drop-down]

[drop-down]

[Click for drop-down]

How did you hear about

this apprenticeship

program?

Did you graduate from

a pre-apprenticeship

program? If yes, which

one?

[Insert sponsor name]

Female

Did not complete high school/GED

Part IV: Additional Documents

Add Occupation Form

Co-sponsor Agreement

Add an Occupation

Sponsor name:

Occupation name:

Date submitted:

Select one:

☐

Original application

☐

Update to program model

If update, indicate

which section:

☐ Work Process ☐ Ratio ☐ Apprentice Wage and Wage Progression

II. APPRENTICESHIP PROGRAM MODEL

The initial application must be submitted with at least one program model. To add another occupation,

use the ‘Add an Occupation’ documents provided in the Appendix of this document. To make updates or

modifications to the apprenticeship program model or wage schedule please resubmit the relevant

portions of this form.

D. Work Process

A work process outlines the skills and competencies an apprentice must be proficient in to become a

fully-qualified employee for the occupation. The apprentice shall receive training and work experience

in order to learn and master these competencies.

Sample work processes already developed by sponsors can be found here

. Rather than starting a work

process from scratch, we strongly recommend you review any available options on the link. To build a

work process, the sponsor can also use the job description as a starting place. If you need assistance

developing a work process, please contact

apprenticeship@mass.gov.

DEFINITIONS

Work process: Skills and competencies an apprentice must be proficient in to become a fully-qualified

employee for the occupation.

Occupation Name: A set of jobs whose main tasks and duties are characterized by a high degree of

similarity (International Labor Office). An occupation name is generic. This is distinct from a job title,

which is often specific to an individual employer.

ONET Code: An ONET code is also a SOC (Standard Occupational Classification Code). It is used by

federal agencies to classify job types.

[Insert sponsor name]

Term of Apprenticeship: The method by which an apprentice is judged to have completed the program

and obtained the required competencies. The Term may be measured through:

• Time-based model: The completion of on-the-job learning (at least ~2000 hours). Models must list

number of hours required for each competency in the RTI/OJT section of the work process.

• Competency-based model: The attainment of competency as demonstrated via evaluation methods

e.g. completion of an exam. Models must show how competency will be evaluated under the

RTI/OJT section of the work process.

• Hybrid model: A blend of the time-based and competency-based approaches. Models must show

how competency will be demonstrated through a combination of hours and evaluation.

Job Function: Main job functions or duties someone in this occupation would be expected to perform

Competency: A set of tasks or skills associated with a particular job function

Related Technical Instruction (RTI): a systematic form of instruction that teaches the apprentice

technical or academic competencies that apply to the job, typically provided in a classroom or online.

For full definition, see Appendix.

On the Job Training (OJT): hands-on training from an experienced journey-level mentor at the job site.

On-the-job training focuses on the skills and knowledge an apprentice must learn during the program to

be fully proficient on the job.

Model requirements

• An apprenticeship must include at least 2000 hours of On the Job Training and 150 hours of

Related Technical Instruction, or approximately one year in length.

• There are no limits or requirements to the number of job functions or competencies associated

with a given apprenticeship model. The template is editable.

• No more than 50% of the program will be accepted as credit for previous experience or training.

• For the purposes of this work process format, list either the number of hours, standard (e.g.

completion of exam), or both that will be required to fulfill a specific competency.

[Insert sponsor name]

Work Process Template

Occupation Name:

ONET Code:

Term of Apprenticeship:

☐

Time based

☐

Competency based

☐

Hybrid

Job Function 1:

Competencies

RTI

OJT

Job Function 2:

Competencies

RTI

OJT

Job Function 3:

Competencies

RTI

OJT

Job Function 4:

Competencies

RTI

OJT

Job Function 5:

Competencies

RTI

OJT

Job Function 5:

Competencies

RTI

OJT

[Insert sponsor name]

Total Hours

E. Ratio of Apprentices to Journey-Level Mentor

The apprentice will be under the general supervision of a journey-level mentor with whom the

apprentice will work and receive on-the-job training. The journey-level mentor is responsible for

ensuring that the apprentice receives the work experience outlined in this document in order to

promote the safety, health and education of the apprentice. Sponsors ensure apprentices are

supervised by competent, qualified journey-level mentors.

DEFINITIONS

Journey-level: level of mastery that is equal to or greater than the term of an apprenticeship.

Journey-level mentor: a worker who has attained a level of skill, abilities and competencies recognized

within an industry as having mastered the skills, abilities, and competencies required for the occupation.

Practical experience must be equal to or greater than the term of apprenticeship. Often a

supervisor/manager, lead staff for a unit, etc.

3. Ratio of apprentices to journey-level mentors:

Apprentice : Journey-level mentor

Describe rationale for ratio here:

Insert #

[Insert sponsor name]

F. Apprentice Wages and Wage Progression