Fillable Plumbers & Steamfitters Local 400 Career Open House (UA Local 400)

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Plumbers & Steamfitters Local 400 Career Open House (UA Local 400)

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Page 1 of 2
Plumbers & Steamfitters Local 400
Youth Apprenticeship Program
Contact Person: DJ Kloida
PO Box 533 Kaukauna, WI 54130-0533
Phone Number: (920) 462-0412
E-Mail: djkloida@ua400.org
Application for Employment with a Signatory Contractor
An Equal Opportunity Employer: All signatory contractors are equal opportunity employers. This application
will be forwarded to them for employment consideration. This application will not be used for limiting or
excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal
law. Applicants requiring reasonable accommodation in the application and/or interview process should notify
a representative of the organization.
Date:
STUDENT INFORMATION:
Name:
First
Middle Initial
Address:
Street
City
State
Zip Code
Phone Number:
Email Address:
Are you currently a student, at least 16 years of age, enrolled at a school with a work-based learning program
sponsored by an accredited school, the technical college system or Department of Workforce Development’s
Youth Apprenticeship Program?
Yes
No
Do you have reliable transportation to and from work?
Yes
No
What date are you available to start work:
Hours Available to Work:
Full Time, Summer Employment
(check all that apply)
Part Time, School Year Employment (indicate the hours you are available to work below)
Mon.
Tue.
Wed.
Thur.
Fri.
Sat.
Start Time:
End Time:
PARENT/GUARDIAN INFORMATION:
Name:
First
Last
Phone Number:
Email Address:
SCHOOL INFORMATION:
Name of High School:
Phone Number:
School’s Youth Apprenticeship Program Administrator:
Youth Apprenticeship Coordinator
First Name
Last Name
Guidance Counselor
First Name
Last Name
Other:
Title
First Name
Last Name
Phone Number:
Email Address:
PREFERRED POSITION/TRADE:
Please select desired Youth Apprenticeship below:
Pipe Welding (Fabrication Shop)
HVAC Service
Steamfitter
Plumber
Page 2 of 2
PLEASE LIST ANY VOLUNTEER OR COMMUNITY SERVICE ACTIVITIES YOU HAVE PARTICIPATED IN (SCHOOL, COMMUNITY, ETC.).
Activity
Organization
Date(s) of Service
PLEASE LIST ANY EDUCATIONAL COURSES, TRAINING PROGRAMS, AND/OR WORK EXPERIENCES YOU HAVE WHICH MAY AID IN
EVALUATING YOUR APPLICATION FOR THE YOUTH APPRENTICESHIP PROGRAM.
Course, Program and/or Experience
Date(s) of Completion
PLEASE LIST ANY RESPONSIBILITIES AND/OR OBLIGATIONS THAT YOU HAVE AFTER NORMAL SCHOOL HOURS (I.E. SPORTS, WORK,
SCHOOL OR COMMUNITY ACTIVITIES, ETC.).
Responsibility and/or Obligation
Start & End Time
Frequency
PLEASE EXPLAIN WHY YOU ARE APPLYING FOR THE YOUTH APPRENTICESHIP PROGRAM (MINIMUM OF 2 PARAGRAPHS IN LENGTH). A
SUCCESSFUL ESSAY WILL INCLUDE INFORMATION AS TO WHY A YOUTH APPRENTICESHIP WILL CONTRIBUTE TO YOUR OVERALL ACADEMIC
AND FUTURE CAREER GOALS. YOU MAY ALSO WANT TO SHARE THE RELATED/TECHNICAL COURSEWORK YOU HAVE TAKEN IN YOUR YA
AREA OF INTEREST. *IF ADDITIONAL ROOM IS NEEDED, ATTACH ADDITIONAL PAGE(S).
A minimum of one (1) formal Letter of Recommendation from a (non-relative) instructor, school staff
member (counselor, principal, etc.), or current employer must accompany your Youth Apprenticeship
Application.
Signature of Student
Date
You will be receiving a confirmation email within 1 business day of submission from career@ua400.org; check
your inbox and/or spam email messages. If you do not receive the email, please call 920-462-0400, ext. 0.
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Plumbers & Steamfitters Local 400 Career Open House (UA Local 400)

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Completed 28 July 2021

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