PHONE:561-842-1063
FAX:561-842-1065
FLORIDA TRAINING SERVICES
Application #____________
No ( )
Do you have reliable transportation? Yes ( ) No ( )
City: State: Zip Code:
Are you a Veteran? Yes ( ) No ( )
Military Status: Active Duty ( ) Reserve ( ) Veteran: Gulf ( ) Vietnam ( ) Other ( )
Education (Mark Highest Grade Completed)
1 2
3 4 5 6 7 8 9 10 11 12 13 14 15 16
Diploma issued in the USA:
H.S. ( ) GED ( )
Name of Last School Attended:
Address:
Eligible for veterans educational benefits: Yes ( ) No ( ) DD-214 Attached: Yes ( ) No ( )
Age: Email:
Sex: Male ( ) Female ( Any Health or Physical Issues: Yes ( ) No ( )
National Origin: Asian ( ) Black ( ) Hispanic ( ) White ( ) American Indian ( ) Other ( )
Are you a U.S. Citizen? Yes ( )
Personal Information
Name (Last): First: Middle:
Street Address:
Note: In compliance with Title 29 Code of Federal Regulations part 30, and the civil Rights Act of
1954, The Committee requests the following information:
Date of Birth:
Cell Phone:
Emergency Contact Name:
Social Security Number:
_ _ _ - _ _ - _ _ _ _
Do you have a state issued Drivers License:
Yes ( ) No ( )
Contact Number:
Home Phone: 
Application For:
FLORIDA CARPENTRY APPRENTICESHIP PROGRAM GNJ
City: State: Zipcode:
( _ _ _ ) _ _ _ - _ _ _ _
( _ _ _ ) _ _ _ - _ _ _ _
( _ _ _ ) _ _ _ - _ _ _ _
_ _ /_ _ /_ _ _ _
PHONE:561-842-1063
FAX:561-842-1065
FLORIDA TRAINING SERVICES
Have you ever been convicted of a felony? Yes __
_
No___
_
If yes, please explain:
_
___________________________________________________________________________________
_
_
___________________________________________________________________________________
_
_
___________________________________________________________________________________
_
_
___________________________________________________________________________________
_
I hereb
y
swear and affirm that all of the above information is true and I understand that an
y
false
information
iven will result in immediate dismissal from the pro
ram.
_____________________________________________ _____________________________________
Si
g
nature Print Name
Dated this _____ da
y
of ________________ , _______.
(Day) (Month) (Year)
Are you Currently Employed: Yes ( ) No ( )
Zi
p
code:
Training and Employment Histor
y
Use this space to list all education and work experience related to the Construction Industry.
Employment Information
Current Employer:
Address:
Cit
y
: State:
Supervisor's Name:
My Employer has agreed to sponsor my apprenticeship: Yes ( ) No ( ) Not Sure ( )
Telephone: ( _ _ _ ) _ _ _ - _ _ _ _
Employment Start Date: Job Title:
_ _ /_ _ /_ _ _ _
PERCEIVED EMPLOYMENT BARRIERS EX- OFFENDER
Do you feel that you possess attitudes, beliefs, customs or practices that inuence Previously or currently subject to any stage
the way you think, act or work which may be a barrier to employment? of the criminal justice process?
nYes (C) nNo (N) n Yes (E) nNo (N)
PROGRAM / COURSE REQUESTED SECTION(S)
FIRST NAME LAST NAME MI
BIRTH DATE (MM/DD/YYYY) STUDENT ID # Do you have a standard diploma/GED? SOCIAL SECURITY #
__ __ / __ __ / __ __ __ __
nYes (31) n No (30) __ __ __ - __ __ - __ __ __ __
FORMER OR MAIDEN NAME (if applicable) IN WHAT COUNTRY WERE YOU BORN? GENDER
n Female n Male
RESIDENCY FOR TUITION PURPOSES: (Check one) Are you: ADULT HIGH SCHOOL DIPLOMA: (AHS students only)
n
A Florida Resident? (4) (F)
n
An Out-of-State Resident? (5) (N)
n
18 Credit Accel (A)
n
24 Credits-HS Diploma (B)
Please answer BOTH questions 1 and 2.
Ethnicity:
1. Are you Hispanic or Latino? (Please choose only one)
n Not Hispanic or Latino
n Yes, Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or
origin regardless of race
Race:
2. What is your race? (Please mark all that apply)
n American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America
(including Central America) and who maintain tribal affiliation or community attachment
n Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent, e.g., Cambodia, China, India, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam
n Black or African American A person having origins in any of the black racial groups of Africa
n Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam,
Samoa or other Pacific Islands
n White – A person having origins in any of the original peoples of Europe, the Middle East or North Africa
IN WHAT COUNTY DO YOU LIVE?
n
Broward
n
Miami - Dade
n
Palm Beach
n
Other ______________________________________
Career, Technical, Adult & Community Education
WORKFORCE EDUCATION REGISTRATION APPLICATION
REGISTRATION APPLICATION DIRECTIONS: Please print and use legal names. Please complete each item. Every item on
this application is required by Florida Statute and/or Florida Administrative Code. If you feel you need assistance to complete
this form please see a staff member at the time of registration.
STUDENTS WITH DISABILITIES: Accommodations and services are available to students with documented
disabilities. If you have any special needs, please arrange an appointment for advisement/counseling with
designated personnel at the school. Reasonable efforts will be made to accommodate your needs.
IF001-WEIM rev: 7/24/17 - daa
ARE YOU CURRENTLY EMPLOYED? (Check one)
n Yes (E) n Not employed (looking and eligible for employment) (U)
nEmployed but with a Notice of Termination or in transition n Not in Labor Force (incarcerated, not eligible for
of military service (S) employment or seeking employment) (N)
HOMELESS/RUNAWAY YOUTH (Check one)
nHomeless but staying without a xed, regular nighttime residence (A)
nHomeless but staying in non-traditional housing (ex. park, abandoned building, or bus station) (B)
nChild of migrants who have changed school districts in the last 3 years due to parents’ seasonal employment (C)
nUnder 18 years of age and who has run away from home or legal residence without permission of his or her family (D)
nDoes not apply (N)
I
S ENGLISH YOUR NATIVE LANGUAGE? n Yes n No CITIZENSHIP (Please indicate your citizenship)
If not, do you have difficulty reading
n Non-Resident Alien (A) n U.S. Citizen (C)
and/or writing the English language?
n Yes (Y) n No nPermanent Resident Alien (P) n Unknown (X)
FINANCIAL ASSISTANCE (Check all that apply) Has student received:
n Pell Grant (A) n SEOG (B) n ITA (WIA) (D) n Other need-based Financial Assistance
such as scholarships or loans (E)
n District Financial Assistance (FAFTF) (F) n Florida Public Postsecondary
Career Education Student Assistance Grant (H)
STUDENT DISABILITY
Does the student request an appointment for Advisement/Counseling to discuss the need for testing/instructional accommodations?
n Yes n No If yes, obtain an Accommodation Advisement/Counseling Request Form to begin the process.
FEE STATUS
n Fee Required (R) n Fee Waived (W) n Fee Deferred (D) n Fee Exempt Code:
Counselor or Designee ______________________________________________________ Date ______________________
Assistance was provided to the
student in completing this form by: ___________________________________________ Date _______________________
SINGLE PARENT/SINGLE PREGNANT WOMEN (Check one)
Are you a:
n Single Parent (S) n Single Pregnant Woman (W) n Both (B) n Does not apply (Z)
HIGHEST SCHOOL GRADE COMPLETED (Check one)
nCompleted at least part of 1st through 11th grade nEarned AAS degree (18)
Highest grade completed __________
nEarned AS degree (19)
nCompleted 12th grade but did not attain a nEarned AA degree (20)
diploma or equivalency (12)
nEarned BA degree (21)
nHave a disability and attained a special diploma or high nAttained beyond a BA degree (22)
school certicate of attendance (15)
nEarned a High School Diploma (D1)
nCompleted some college (16) n Earned a high school equivalency (GED
®
Diploma) (G1)
nEarned a Career Certicate (17) nNo school grades completed (ZZ)
Where was this level achieved?
nU.S.-based school (U) nNot U.S.-based school (N) nUnknown (X)
DISPLACED HOMEMAKER (Check one)
n Previously unemployed or underemployed while caring for home and family (unpaid) (A)
nPreviously supported by public assistance or family, and now unemployed and underemployed (B)
nParent of a child within two years of no longer receiving TANF (formerly AFDC) (C )
nUnemployed dependent spouse of a member of the Armed Forces who is on active duty/deceased or disabled as a result of
military service (D)
nDoes not apply (Z)
STUDENT’S ADDRESS APT. CITY STATE ZIP CODE
STUDENT’S E-MAIL STUDENT’S
TELEPHONE NUMBER
CELL ( __ __ __ ) __ __ __ - __ __ __ __ HOME: ( __ __ __ ) __ __ __ - __ __ __ __
EMERGENCY CONTACT NAME PHONE: ( __ __ __ ) __ __ __ - __ __ __ __
The School Board of Broward County, Florida, prohibits any policy or procedure which results in discrimination on the basis of age, color, disability, gender identity, gender expression, national origin, marital status, race, religion, sex or sexual orientation. Individuals who wish to file a discrimination and/or
harassment complaint may call the Director, Equal Educational Opportunities/ADA Compliance Department at 754-321-2150 or Teletype Machine (TTY) 754-321-2158. Individuals with disabilities requesting accommodations under the Americans with Disabilities Act Amendments Act of 2008, (ADAAA) may
call Equal Educational Opportunities/ADA Compliance Department at 754-321-2150 or Teletype Machine (TTY) 754-321-2158.
- OFFICIAL USE ONLY -
INTERNATIONAL STUDENTS (Technical Program Applicants)
Do you have an approved M-1 Visa?
n Yes n No International Student Advisor verification: _______________(initials)
I hereby certify that the information on this application is accurate to the best of my knowledge. I further certify that I am not
currently expelled from the Broward County Public Schools.
Student Signature __________________________________________________________________ Date _______________
MIGRANT/SEASONAL FARM WORKERS (Check one)
n Low-income individual (or their dependent) employed primarily in farming and currently unemployed or finding difficulty obtaining
work for 12 months out of the last two years. (A)
n Migrant or seasonal farm worker (or their dependent) (B) n Does not meet the conditions described above. (N)
ARE YOU A U.S. MILITARY VETERAN? (Check one)
n Active Duty (A) n Active Member of the Reserves (R)
n Eligible Dependent (spouse or child) (D) n Veteran (service prior to 9/11/2001) (V)
n Veteran (service dates unknown) (E) n Veteran (service on or after 9/11/2001) (W)
n Active Member of the National Guard (N) nNo Military History (Y)
Mydocuments/ApplicantPacket/Packet/Apprenticeship Release[Title]
THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA
APPRENTICESHIP AUTHORIZATION FOR RELEASE AND/OR
REQUEST FOR INFORMATION
I, _______________________________________________________ hereby request and authorize
Apprentice Name
Atlantic Technical College, located at 4700 Coconut Creek Parkway, Coconut Creek, Florida 33065 to
engage in verbal and/or written communication with and release records to, and receive records from
_____________________________________________________________________________________
Name and address of Apprenticeship Program Agency
Types of information to be released and/or received:
Grades
Funding Verification Report
Test Scores WDIS Occupational Completion Point (OCP)
Verification Reports
Attendance Reports
Apprenticeship Change of Enrollment Form
Forms Signature Page Code and Discipline Code for Adult Students
Workforce Development Information System
(WDIS) Application
(
including Social Security Number, Date of Birth, Race, Ethnicity
Any relevant form(s) necessary for
participation in an approved
Apprenticeship Program
Florida Identification Number Other: ____________________________________
Purposes of Disclosure:
SBBC shall provide AGENCY and AGENCY'S support staff the documents listed in this section, for the
purpose of registration, verifying Full-Time Equivalent (FTE) status for state funding, processing
Occupational Completion Point (OCP) form to follow student progress and advancement toward
completion, and inputting data into FOCUS database to record attendance.
I acknowledge that all information I
authorize to be released or requested will be held strictly confidential
and cannot be released by either recipient without additional written consent, except as required or
permitted by law. I understand this authorization will expire upon termination of the program by
Apprentice or full completion of the apprenticeship program.
Print Name
Apprentice Signature Date
Florida Training Services
Forms Signature Page
Date: ____________________________________
My signature on this page indicates that I have received, read and understand the policies and
procedures as outlined in the provided Atlantic Technical College forms. These forms include:
Career Technical, Adult & Community Education Workforce Education Registration Application,
Authorization for Release and/or Request for Information, Conduct and Discipline Code for Adult
Students, and Student Grievance Procedure.
Student’s name (please print)
Student’s signature
Student’s email address
STUDENT NAME: (Print Clearly)
STUDENT IDENTIFICATION NUMBER:
Career, Technical, Adult & Community Education
2019-2020 WORKFORCE EDUCATION REGISTRATION APPLICATION ADDENDUM
Name: Student ID:
Income Status
Please answer ALL questions related to any income barrier you feel you possess. This information is required by the Florida
Department of Education. All responses are kept secure and confidential.
1.
Will you exhaust your TANF (Temporary Assistance for Needy Families) benefit within the next two (2) years?
Yes (A)
No
Does Not Apply
2.
Have you been unemployed for the last 27 or more weeks?
Yes (B)
No
3.
Do you identify yourself as being low income? Some examples of being low income may include:
Examples For Reference ONLY
Being a member or having a member of your immediate family receiving
benefits through SNAP/TANF, SSI and/or other state public assistance.
A youth who receives free or reduced lunch in school.
Currently in a foster care program.
Being a person with disability AND a personal income at or below the
poverty line, regardless of family income.
Currently homeless.
Currently a youth who is living in high-poverty area.
Yes, one or more of the above in Question #3 apply to me (C)
No, none of the above in Question #3 apply to me
Persons in
Household
Low
Income
Guidelines
1
2
3
4
5
6
7
8
$12,490
$16,910
$21,330
$25,750
$30,170
$34,590
$39,010
$43,430
For households with more
than 8 persons, add $4,420
for each additional person
Si
g
nature of Student Date
IF 040 - WEIM 11/8//2019
Broward County Public Schools
The School Board of Broward County, Florida, prohibits any policy or procedure which results in discrimination on the basis of age, color, disability, gender identity, gender expression, genetic information, marital status, national
origin, race, religion, sex
or sexual orientation. The School Board also provides equal access to the Boy Scouts and other designated youth groups. Individuals who wish to file a discrimination and/or harassment complaint may call the Director,
Equal Opportunities/ADA Compliance Department & District’s Equity Coordinator/Title IX Coordinator at
754-321-2150 or Teletype Machine (TTY) 754-321-2158. Individuals with disabilities requesting accommodations under the Americans
with Disabilities Act Amendments Act of 2008, (ADAAA) may call Equal Educational Opportunities (EEO) at 754-321-2150 or Teletype Machine (TTY) 754-321-2158.
Florida Training Services, Inc.
8011-B Monetary Drive
Riviera Beach, FL 33404
Phone (561) 842-1063 FAX (561) 842-1065
POLICIES AND PROCEDURES
FL Carpenter Apprenticeship
1. All Apprentices are required to attend at least 144 hours of related instruction (class
time) per year. Apprentices are required to call the Coordinator ( Waine Weeks (954) 696-
5494) if they miss school. If more than 4 classes a semester are missed through unexcused
absents the Apprentice will receive a written warning. If the absents continue the Apprentice will
be brought before the Apprenticeship Committee. Further absents could mean dismissal from the
school.
2. Classes will begin at the scheduled times. If an Apprentice shows up 20 minutes late
with out a reasonable excuse they will be marked late. Three late makings in a
semester will count as one absent.
3. Apprentices will be required to wear appropriate clothing in classes (jeans & sleeved shirts)
and work boots and or closed toed shoes that cover the ankles for safety reasons.
Excessively baggy clothes, tank or sleeveless shirts, loose jewelry, sandals, flip flops, and
slides/slippers are not permitted. For safety reasons pants and shirts worn to class must not have
holes or be tattered and torn. Long hair must be pulled back out of the face and secured.
4. No horseplay, swearing or cursing, fighting, gambling, drinking alcohol, or drug use
will be allowed on any of the class premises.
5. No smoking in classrooms or lab space.
6. If an Apprentice is suspected of being under the influence of drugs or alcohol they will
be requested to leave the class and required to appear before the Apprenticeship
Committee for further action.
7. Apprentices will respect the property of the school (Tools, books, furnishings,
building, equipment, etc.).
8. Apprentices are required to fill out a monthly work report and to be signed by their
Foreman or Journeyman. Any Apprentice not turning an accurate work report on a
monthly basis will cause their pay increases to be late.
9. Apprentices are not allowed to bring pets, children, or other uninvited guests to class
(without permission from Director, Coordinator or Instructor)
10. I have reviewed and agree to follow the conduct and discipline code for Adult Students
attending Secondary classes at Atlantic Technical College.
On the Job Training
Typically, the length of your apprenticeship will be 2-4 years. During this period you will
be granted credit for the work experience you gain on the job. The on-the-job training
component is an important part of your apprenticeship. To ensure that you are granted
credit, you will be required to complete a work process sheet on a monthly basis. It will be
your responsibility to give this record to Florida Carpenter Apprenticeship Coordinator for
entry into your training record. Prior to entering the program, you are required to be
employed in the Carpentry trade with a sponsoring employer (someone willing to sponsor
you as an apprentice).
I have read, understand and received a copy of the Policies and Procedures that are listed
above; I have also been offered to read and understand the Registered Apprenticeship
Standards of the Florida Carpenter Apprenticeship Program. I understand and agree to
abide by the rules and regulations set
___________________________________ ____________________________________
Signature Print name Date
[ ]
Date: /
/
By:
[ ]
Date: /
/
By:
,
between the parties to
APPRENTICE, and (if a minor)
TO BE COMPLETED BY APPRENTICE
(Please check or fill in items as appropriate)
(* Indicates a REQUIRED FIELD) Remaining Fields are VOLUNTARY
1. Social Security Number
*
2. Date of Birth (xx/xx/xx)
*
3. Sex 4. Ethnic Group (optional) 5. Race
(optional)
Male
Asian
White
Female
7. Veteran (optional) 8. Career Connection (optional)
8th grade or less Veteran
None
Military Veterans HUD/StepUp
Non-Veteran
Preapprenticeship
Job Corps Career Center Referral
High School Equivalency Technical Training School YouthBuild School to Registered Apprenticeship
Data entered by:
Sponsor Registration Agency
Starting Wage:
(Street Address)
APPRENTICESHIP AGREEMENT: Between the Apprentice and the Apprenticeship Program Sponsor
Warning: This Apprenticeship Agreement does not constitute an
Apprentice Certification under Title 29, CFR, Part 5 for the employment
of the Apprentice on Federally financed or assisted construction
projects. Current Apprentice Certifications must be obtained from the
Registration Agency's Servicing Representative.
Probationary Period:
Apprentice I.D. #:
RAPIDS Code:
Credit for Previous
Experience:
I, the above named APPRENTICE, with full knowledge of the provisions and my rights thereunder, do hereby expressly waive my rights under 20 USCA S1232g(b) which provides that a student's
permission (or the permission of his/her guardian, if the student is under 18 years of age) is necessary before an educational agency or institution may disclose the student's education records to
any source outside the school system. Permission to disclose my records (or my child's records) is specifically restricted to the disclosure of grades and attendance records to the Registration
Agency for the purpose of evaluating my progress as an apprentice and further administering of the Florida Apprenticeship Program provided for under Chapter 446, Florida Statutes.
SIGN IN BLUE INK (Legal Signature of Apprentice)
(State)
(City)
(Title)
Month
Term:
WITNESSETH THAT:
The Program Sponsor agrees to be responsible for the selection, placement and training of said apprentice, as work is available, and in
consideration said apprentice agrees diligently and faithfully to perform the work of said trade during the period of apprenticeship, in accordance with the registered standards of
the Program Sponsor. The apprenticeship standards referred to herein are hereby incorporated in and made a part of this agreement. This agreement may be terminated by
mutual consent of the signatory parties, only upon proper notification to the Registration Agency.
(Zip Code)
(State)
(Zip Code)
(City)
(If a Minor - Parent or Guardian Signature)
Term Remaining:
(Mailing Address of Program Sponsor)
SIGN IN BLUE INK (Signature Representing Program Sponsor)
(PRINT: Full Legal Name of Apprentice)
(PRINT: Parent or Guardian Name for Minors ONLY)
Participating Employer:
O*Net
SOC Code:
Trade:
hereinafter referred to as his/her GUARDIAN.
To Be Completed by Dept. of Education)
Division of Career and Adult Education - Apprenticeship
Canceled
Florida Department of Education
Program Sponsor #:
Completion Date
represented as the
Apprenticeship Sponsor and
(Name of Local Program Sponsor's Registered Apprenticeship Standards)
day of
THIS AGREEMENT, entered into this
hereinafter referred to as the
DCAE Form APPR-200 (Revised 1/20)
(Registration Date)
Registered by: Division of Career and Adult Education - Apprenticeship
“Discrimination on the basis of 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 against a student, employee or applicant in any education program, activity or employment is prohibited. Any
information requested related to protected classes is used for state and federal reporting purposes only and will not be used in a discriminatory manner."
THIS AREA FOR DEPARTMENT OF EDUCATION USE ONLY
High School Graduate or
Greater
Authorized Official, Registration Agency / Date Approved
/
No
Yes
9. Disability (optional)
Post Secondary or
Technical Training
Day
Year
(only used for training record identification)
American Indian or
Alaska Native
Native Hawaiian or Other
Pacific Islander
Black or African
American
Unknown
6. Mark Highest Grade of Schooling Completed
Not Hispanic or
Latino
9th to 12th grade
Hispanic or Latino
Florida Carpenters Apprenticeship Program GNJ
Carpenter
47-2031.00
999
24 Months
12 Months
Coorindator
Po Box 859
Palm City,
FL
34991
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