Fillable APPLICATION FORM Apprenticeship 1 - TRADE Trade (Government of Nunavut)

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APPLICATION FORM Apprenticeship 1 - TRADE Trade (Government of Nunavut)

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Country of origin: CANADA
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1/9
All sections are mandatory - Place a dash or line through boxes that do not apply to you.
Apprenticeship
APPLICATION FORM
2 - PERSONAL INFORMATION
1 - TRADE
3 - CONTACT INFORMATION
Trade
Mr. Ms. Mrs.
Last Name First Name
Former last name (if applicable) Middle Name
Gender M F
Date of Birth - YY-MM-DD
Social Insurance Number
Nunavut Health Card Number Nunavut Student ID Number
Aboriginal Identity: Inuit First Nations Metis Non-Native Person Identifying with More than One Group Unknown
Inuit Land Claims Beneciary :
Yes No
Are you a member of any of the following groups? (Optional) - Disability or activity limitations
Hearing Impaired Vision Impaired Wheel Chair Access None Unknown
Person with More than One Disability or Active Limitation
Best method to contact me is: Telephone Email Mail
Permanent Mailing Address
Mailing Address
Community Territory/Province Postal Code
Telephone (Home)
( )
Telephone (Work)
( )
Fax
( )
Telephone (Cell)
( )
Email Address
2/9
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Alternate or Temporary Address
Mailing Address
Community Territory/Province Postal Code Telephone
( )
Communication Preferences
I prefer receiving my information in:
English French
Language(s) spoken: English French Inuktitut Inuinnaqtun Other
Language(s) written: English French Inuktitut Inuinnaqtun Other
4 - EDUCATION AND TRAINING
Are you currently attending a Nunavut high school? Yes No
Previous certications in this trade
Apprentice (regular route) or
NEAT (Nunavut Early Apprenticeship Program)
Pre-Apprenticeship Program
NAC’s Pre-Trades course or Trades Access course
Certicate of Diploma courses in Trades Training
Name of High School
(currently attending or most recently attended)
Last year attended
YYYY-MM
Address
Community Territory/Province Postal Code
Please indicate the highest grade level completed:
NUNAVUT TRADES ENTRANCE EXAM:
Have you written a Nunavut Trade Entrance Exam Yes No
Level of TEE
1 2 3 4 5
Date written:
YYYY-MM-DD
Location
Results
Pass Fail
Overall Mark %
Previous Trades Training after High School NOT including Apprenticeship Training
COURSE OR PROGRAM INSTITUTION LOCATION
DATE STARTED
(YY - MM)
DATE
COMPLETED
(YY - MM)
CERTIFICATE /
DIPLOMA ETC.
OBTAINED
3/9
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PREVIOUS APPRENTICESHIP & TRADE CERTIFICATION INFORMATION:
Have you been enrolled in an apprenticeship program in another province or territory? Yes* No*
* If “Yes”, please complete this section,
if “No” please go to the next page.
PREVIOUS CERTIFICATIONS
TRADE
APPRENTICESHIP COMPLETED?
Yes No Yes No Yes No
YEAR ENROLLED
YEAR COMPLETED
LEVEL COMPLETED
PROVINCE/TERRITORY
JOURNEYMAN CERTIFICATE NO.
DATE OF ISSUANCE
(YY- MM-DD)
PROVINCE OF ISSUANCE
RED SEAL / IP CERTIFICATE NO.
DATE OF ISSUANCE
(YY- MM-DD)
PROVINCE OF ISSUANCE
Please attach a ‘certied true copy’* of all supporting documentation (ex. trade certicate, diploma, credential or transcript)
to your application. (* A certied copy that is a copy certied to be an exact copy of the original. A lawyer or a notary public
or Commissioner of Oath can do this for you.)
4/9
5 - WORK EXPERIENCE / EMPLOYMENT HISTORY
Applicant’s Work Experience in the Trade.
Willingness to Move:
Are you willing to move for employment? Yes No
Are you willing to move for training? Yes No
EMPLOYMENT HISTORY (PLEASE LIST MOST RECENT FIRST)
Business Name
Business Mailing Address
Community Territory/Province Postal Code
Business Telephone
( )
Business Fax
( )
Contact Person Position / title of contact person:
Date Started
YYYY-MM-DD
Date Finished
YYYY-MM-DD
Total Months Total Hours
Duties
Type of employment
Full-time Full-time seasonal Part-time Other : __________________________________________________
Business Name
Business Mailing Address
Community Territory/Province Postal Code
Business Telephone
( )
Business Fax
( )
Contact Person Position / title of contact person:
Date Started
YYYY-MM-DD
Date Finished
YYYY-MM-DD
Total Months Total Hours
Duties
Type of employment
Full-time Full-time seasonal Part-time Other : __________________________________________________
5/9
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6 - APPLICANT CONSENT TO DISCLOSE INFORMATION ON FILE
I, ______________________________________________________________________________
PLEASE PRINT YOUR FULL NAME
understand that to administer, monitor and evaluate my apprenticeship training, the Apprenticeship Unit may need to
obtain and provide personal information about me to:
• My sponsoring employer.
• Other Government of Nunavut Departments such as Family Services or Economic and Social Development Canada to assist
in obtaining nancail support.
• The Workplace Safety and Health Branch, the Employment Standards Branch, Labour Standards Compliance Ofce -
Department of Justice, Department of Executive and Intergovernmental Affairs and the Community and Government Services
(CGS) to administer and enforce workplace legislation.
• Accredited training providers that provide technical training to me.
• Transport Canada for program audit and/or licensing purposes
• Government ofcials responsible for apprenticeship or trade certication programs in Canadian provinces and territories to
verify my status under the Nunavut Apprenticeship program.
• Canadian Council of Directors of Apprenticeship (CCDA) and Human Resources and Skills Development Canada (HRSDC)
ofcials to administer the Interprovincial Standards Red Seal Program and /or to conrm my status as a Red Seal program
client listed in the Interprovincial Computerized Examination Management System (ICEMS) database.
• Groups, organizations or associations for general trade-related correspondence, or to be considered for an honour or award.
• Employers or employer groups seeking to hire or work with apprentices.
• Employers and associations related to awards that I may be eligible for, for the purpose of recognition.
• I also agree that the Department of Education may identify me by name, course of study, and such other identifying information
as class year, graduation date, hometown, etc. for the media for purposes of celebrating accomplishments
Note:
• You may withdraw your consent at any time but must do so in writing to your nearest Nunavut Department of Family
Services ofce.
• Your consent is voluntary. If you do not give your consent, it will not stop your application from being considered or stop
your participation in an apprenticeship program. However, it may restrict your ability to receive an award recognizing your
achievement as an apprentice or from being considered for a scholarship.
• Sign and date your consent to disclose personal information.
• Under the authority of the Statistics Act (Canada), the Nunavut Apprenticeship Unit shares identifying personal information
with Statistics Canada to conduct statistical surveys with individuals. Reports and information produced by Statistics Canada
from these surveys do not identify any individual or individuals. The Apprenticeship Unit may share non-identifying bulk
information with Statistics Canada and other Canadian provinces and territories to maintain national statistics and records.
I authorize the Nunavut Apprenticeship Unit and these persons and entities to share such personal
information about me as may be necessary for these purposes.
Signature of Apprentice Date (YYYY-MM-DD)
Parent/Guardian’s Signature
(if Apprentice is under age 19)
Date (YYYY-MM-DD)
6/9
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7 - EMPLOYER INFORMATION
(TO BE COMPLETED BY EMPLOYER)
Legal name of business
Operating name of business
Mailing Address
Community Territory/Province Postal Code
Business Telephone
( )
Business Fax
( )
Business Cell
( )
Contact Person E-mail Address
What date did the applicant begin to work in this trade for your business (yy-mm-dd)?
Has the applicant’s employment been continuous since that date? Yes No
SUPERVISING JOURNEYPERSON (SJP)
Name
Trade
Certicate Number
Province / Territory
Postal Code
Reminder : Please attach a copy of SJP’s certicate.
WAGES
Please indicate the lowest pay rate for a newly certied journeyperson your rm would normally use in this trade:
$ _______________________ / h
Is your application related to any special project?
Yes No
Agnico Eagle Bafn Land Mines New 2013 Housing Project Iqaluit Airport Project
Other:
___________________________________________________
Details
Apprenticeship Application
EMPLOYER INFORMATION
7/9
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Apprenticeship Application
EMPLOYER RECOMMENDED TERMS
FOR THE APPRENTICESHIP AGREEMENT
The following information is intended to be the basis upon which the Employer and Apprentice agree to move forward in establishing
a Contract for Apprenticeship:
The Employer agrees to accept the Apprentice as his apprentice in the designated trade outlined in this application and the Apprentice agrees
to serve the Employer as his apprentice in the designated trade for the term of the Contract of Apprenticeship (which will be created by the
Apprenticeship Unit after review of this application)
Employer Recommendations:
It is recommended that the apprentice named in this application, based on previous work experience (as shown on the attached VTE form) be
credited the following time credit, trade instruction course requirement and/or examinations at the levels outlined below:
LEVEL
APPRENTICESHIP
TIME REQUIRED
CREDIT
(SUBTRACT)
BALANCE OF
APPRENTICSHIP
TIME REQUIRED
TRADE
INSTRUCTION
COURSES
REQUIRED
EXAMINATIONS
REQUIRED
1 1800
Yes No Yes No
2 1800
Yes No Yes No
3 1800
Yes No Yes No
It is understood that the following conditions will be set out within the Contract of Apprenticeship
•
The parties agree that the apprenticeship program in the designated trade is not complete until the Apprentice has
obtained a certicate of qualication in the designated trade.
•
The Apprentice agrees to work for the Employer as an apprentice and to be trained in the designated trade.
•
The Employer agrees to train the Apprentice in all aspects of the designated trade as far as his facilities and the scope of
his business will permit.
•
The parties agree that the Apprentice shall be paid wages at a rate not less than that established by Section 23 of the
Apprenticeship, Trade and Occupations Regulations.
•
The parties agree to maintain regular communication with the representatives of the Nunavut Department of Education
Apprenticeship Unit and afliated staff to fulll the duties and obligations of the parties as outlined within the
Apprenticeship, Trade and Occupations Act and Regulations.
APPRENTICESHIP UNIT: OFFICE USE ONLY
This application has been reviewed and veried and the recommendations above are :
Approved Denied Approved with the following modications/conditions:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Name of Supervisor / Registrar Signature Date (YYYY-MM-DD)
1800
1800
1800
8/9
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8 - EMPLOYER CONSENT TO DISCLOSE BUSINESS INFORMATION (OPTIONAL)
I authorize the Nunavut Apprenticeship Unit to disclose to recognized groups, organizations, associations, or
businesses, business-identifying information as it relates to participation in a Nunavut Apprenticeship program for
general trades related correspondence, for consideration of an honour or award.
Yes No
I also authorize the Unit to disclose business-identifying information as it relates to participation for the purposes of
promotion of the Nunavut Apprenticeship program on the Apprenticeship Unit website.
Yes No
Signature of Employer Date (YYYY-MM-DD)
Apprenticeship Application
EMPLOYER CONSENT FORM
9/9
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9 - APPRENTICESHIP AGREEMENT
Please read this section carefully and sign if you agree. Both the employer and applicant for apprenticeship must sign this Agreement in
order for it to be processed and a Contract of Apprenticeship created.
If the applicant is under the age of 19 y, a parent or guardian must also sign this Application/Agreement.
Note: It is an offence under the Canada Evidence Act to provide false information
Obligations:
Subject to the terms, recommendations and information previously supplied within this application:
The apprentice shall:
a. Observe the established hours of work and not absent himself/herself without good cause.
b. Show due regard for the tools and goods of the employer and avoid damage and waste of those tools and goods insofar as he/
she is able.
c. Follow safe work practices to the best of his/her ability.
d. Attend regularly the training courses prescribed by the Supervisor of Apprenticeship Unit – Career Development and Family
Services - Nunavut Department of Education and/or designated staff, and be responsible to cover specic expenses identied
for such training.
e. Cover any additional costs including accommodations on location, meals, local transportation, safety and damage deposits.
(Student fees, lab fees and accommodation fees at the technical training institute at registration on training site)
f. Notify the Regional Director of Career Development and Family Services through the assigned Career Development Ofcer
(CDO) in his/her region immediately when he/she ceases to be employed by the employer signatory to this Agreement.
g. Maintain regular communication both with the designated Career Development Ofcer (CDO) handling his/her case and the
staff of the Apprenticeship Unit as required.
The employer shall:
a. On request from the Apprenticeship Unit – Adult Learning Services - Nunavut Department of Education and/or
designated staff, provide such relevant information as may be requested regarding employees and their qualications
in designated occupations.
b. Provide adequate training for the apprentice in all areas of the trade insofar as his/her facilities and the type of work permit.
c. Provide supervision by a qualied journeyperson in accordance with the Apprenticeship, Trade and Occupations
Certication Regulations.
d. Cooperate with the Regional Director of Career Development and Family Services and/or designated staff (CDO) in the
transfer of the terms and conditions of the Contract of Apprenticeship as appropriate
e. Encourage and allow the apprentice to attend such training courses as prescribed by the Supervisor of Apprenticeship Unit –
Adult Learning Division - Nunavut Department of Education
f. Notify the Regional Director of Career Development and Family Services and/or designated staff (CDO) immediately of any
difculties that may occur respecting this Apprenticeship Agreement and the associated Contract of Apprenticeship.
g. Notify the Regional Director of Career Development and Family Services and/or designated staff (CDO) immediately when he/
she ceases to employ the apprentice signatory to this Agreement and the associated Contract of Apprenticeship.
Signature of Apprenticeship Applicant Name of Apprenticeship Applicant
(please print)
Date
(YYYY-MM-DD)
Signature of Parent/Guardian
(If Apprentice is under 19y)
Name of Parent/Guardian
(please print)
Date
(YYYY-MM-DD)
Signature of Sponsoring Employer Name of Sponsoring Employer
(please print)
Date
(YYYY-MM-DD)
Apprenticeship Application
APPRENTICESHIP AGREEMENT
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APPLICATION FORM Apprenticeship 1 - TRADE Trade (Government of Nunavut)

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Completed 8 February 2021

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