Welcome to the APHCC of Alabama Plumbing Apprenticeship Program
Thank you for your interesting this program, and the journey you are about to undertake to advance your
knowledge and career in the plumbing industry.
In order to become a part of this program, follow these steps: Step 1 Complete the following Application for Admission. Step 2 Send the completed application to the APHCC of Alabama. You may send the application via mail or scan/e-mail to: Mail: APHCC of Alabama P.O. Box 36972 Birmingham, AL 35236 E-Mail: [email protected] Step 3 When you have received approval from the Education Committee, you will be instructed on method of payment for the $1500.00 per year tuition. P.S. DO NOT send your tuition payment with your application! According to U.S. Department of Labor standards, you will not be asked to submit your tuition payment until AFTER your application has been approved. Upon receipt of your tuition payment, you will be enrolled in Apprenticeship Program. The program directors will contact you with instructions on how to begin and use the online system.
GOOD LUCK!!
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! Associated*Plumbing*–*Heating*4*Cooling*Contractors*of*Alabama** APPLICATION*FOR*APPRENTICESHIP*______________________________________________________________________________!
Complete(this(application(and(mail(to:(APHCC(of(Alabama,(P.O.(Box(36972,(Birmingham,(AL(35236(PLEASE!PRINT! APPLICATION!DATE!_______________!
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Social!Security!Number_____!;!___!;!_______! Please!check!trade!of!interest:!Plumbing!___!
! ! Heating/Cooling!___!
!Full!Legal!Name:!
o!Mr.!o!Ms.!
o!Miss!o!Mrs.!
Last! First! Middle! Nickname!
Current!Address! Street!&!Apt!#! City! State! ZIP!
Permanent!
Address!
Street!&!Apt!#! City! State! ZIP!
Contact!Number!
(with!area!code)!
Home! Mobile! Work! Email!
Emergency!
Contact!
Name! Address! Relationship! Phone!Number!
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FEDERAL/STATE*REPORTING*REQUIREMENTS*The!following!information!is!only!
for!federal/state!reporting!
requirements.!The!information!you!
provide!below!will!not!in!any!way!
affect!the!admission!decision.!
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Sex:!Male!__!Female!__!
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American!Indian! __!
Black/Non;Hispanic! __!
White/Non;Hispanic! __!
Asian/Pacific!Islander! __!
Hispanic! __!
Other! __!
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CITIZENSHIP*U.S.!Citizen!__! !
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Permanent!resident!
(non;citizen)!__!
Country!of!citizenship!other!than!
U.S.!_______________!
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ENTRY*STATUS*!
High!School!student! __!
High!School!Graduate! __!
Earned!GED! __!
Some!college! __!
College!Graduate! __!
Other! __!
!MILITARY*STATUS*!
Veteran!of!Armed!Services! __!
Will!use!VA!benefits! __!
Active!Duty!Military! __!
!!!!!!!!!!!!!Rank!_____________!
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Retired!Military! __!
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EMPLOYMENT*STATUS*!
Currently!Employed! __!
Employed!in!the!trades! __!
Employed!full;time! __!
Employed!part;time! __!
Need!employment! __!
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If!employed,!please!give!the!following!information:!
Employer! ___________________________________!
Address!_____________________________________!
Phone! ______________________________________!
Supervisor!__________________________________!
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If!a!student,!please!give!the!following!information:!
High!School! !_________________________________!
Phone! _____________________________________!
Counselor! ___________________________________!
Teacher!_____________________________________!
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Employment*Information*for*APHCC*of*Alabama*Apprenticeship*Program**PLEASE*PRINT!!
Name!___________________________________!Social!Security!#!______!;!_____!;!_________!
!LIST*EMPLOYMENT*INFORMATION*BEGINNING*WITH*THE*MOST*RECENT*EMPLOYER*FIRST!
EMPLOYER* ADDRESS* JOB*TITLE* SUPERVISOR* PHONE*#* DATES*!
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From!_____/_____!
!To!_______/_____!
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From!_____/_____!
!To!_______/_____!
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To!_______/_____!
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From!_____/_____!!
To!_______/_____!
HOW*WOULD*AN*EMPLOYER*DESCRIBE*YOU*AS*AN*EMPLOYEE?*******HOW*WOULD*A*TEACHER*DESCRIBE*YOU*AS*A*STUDENT?*******!
PLEASE*READ*CAREFULLY*AND*SIGN**
I!certify!that!all!statement!contained!herein!are!correct!and!complete!and!I!further!agree!that!if!
any!of!the!information!I!am!providing!herein!shall!be!discovered!by!the!Associated!Plumbing,!
Heating!and!Cooling!Contractors!Apprenticeship!Program!to!be!false!or!incomplete,!then!the!
Apprenticeship!Committee!shall!have!the!right!to!suspend!or!discontinue!my!enrollment!in!the!
program.!
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Signature! ! Date!
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Educational*Information*for*APHCC*of*Alabama*Apprenticeship*Program*!
PLEASE*PRINT!!
Name!___________________________________!Social!Security!#!______!;!_____!;!_________!
!HIGH*SCHOOL*INFORMATION*FOR*APHCC*OF*AL*APPRENTICESHIP*
*HIGH*SCHOOL*LAST*
ATTENDED***
CITY,*STATE* DATES*OF*ATTENDANCE**
FROM!________/_______!
TO!__________/________*
DID*YOU*EARN*YOUR*DIPLOMA?**
o!YES!!!!!!!!o!NO*DATE*OF*HIGH*SCHOOL*GRADUATION*(OR*EXPECTED):* MONTH*_____________________*
YEAR_____________*IF*YOU*DID*NOT*EARN*A*HIGH*SCHOOL*DIPLOMA,*PLEASE*PROVIDE*GED*INFORMATION*HERE.*
HAVE*YOU*EARNED*A*GED?**o!YES!!!!!!!!!!!!!o!NO*
WHEN*AND*WHERE*DID*YOU*COMPLETE*YOU*GED?*YEAR________*LOCATION*_________________**
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COLLEGE*IFORMATION*FOR*APHCC*OF*AL*APPRENTICESHIP**
LIST*ALL*COLLEGES*ATTENDED*(MOST*RECENT*FIRST)*INSTITUTION* CITY,*STATE* DATES*OF*ATTENDANCE* DID*YOU*GRADUATE?*
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* FROM!________/_______!
TO!__________/________!
*o!YES!!!!!!!!!!!!!!!!!o!NO!
* * FROM!________/_______!
TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*
* * FROM!________/_______!
TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*
* * FROM!________/_______!
TO!__________/________**o!YES!!!!!!!!!!!!!!!!!o!NO*
*IF*YOU*GRADUATED,*TYPE*OF*DEGREE*___________________________*GRADUATION*DATE*_________________*PLEASE*PROVIDE*ANY*FORMER*NAMES*YOU*MAY*HAVE*USED*WHILE*ATTENDING*SCHOOL:***
PLEASE*READ*CAREFULLY*AND*SIGN**
I!certify!that!I!comply!with!the!provisions!of!the!United!States!Military!Selective!Service!Act!(50!U.S.C!
App!453)!by!having!registered!with!the!Selective!Service!Board!or!that!I!am!not!yet!18!years!of!age!and!I!
will!register!when!required!or!that!I!am!not!required!by!law!to!register.!(This!certification!is!required!by!
the!State!of!Alabama!Legislative!Act!91;584.)!
!
I,!the!undersigned!applicant!for!admission,!understand!that!withholding!information!requested!in!this!
application,!or!giving!false!information,!will!make!me!ineligible!for!the!admission!to!the!APHCC!of!
Alabama!Apprenticeship!Program.!I!certify!that!all!statements!contained!herein!are!correct!and!
complete!and!I!further!agree!that!if!any!of!the!information!I!am!providing!herein!shall!be!discovered!by!
the!APHCC!of!Alabama!Apprenticeship!Program!to!be!false!or!incomplete,!then!the!Apprenticeship!
Committee!shall!have!the!right!to!suspend!or!discontinue!my!enrollment!in!the!program.!
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Signature! ! Date!
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!Career*Information*for*the*APHCC*of*Alabama*Apprenticeship*Program*
*WHAT*IS*YOUR*PRIMARY*REASON*FOR*APPLYING*TO*THE*APPRENTICESHIP*PROGRAM?*(CHECK*ONE)**o!LEARN*SKILLS* o!EARN*CERTIFICATE*TO*
ADVANCE*IN*A*JOB!o!EARN*DEPARTMENT*OF*LABOR*CERTIFICATION!
o!WORK*WHILE*EARNING*CERTIFICATION!
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HOW*WOULD*YOU*RATE*YOURSELF*ON*THE*FOLLOWING:**Math!Ability! o!!high! o!!average! o!!low!
Reading!Ability! o!!high! o!!average! o!!low!
Problem!Solving! o!!high! o!!average! o!!low!
Critical!Thinking! o!!high! o!!average! o!!low!
Team!Work! o!!high! o!!average! o!!low!
Mechanical!Ability! o!!high! o!!average! o!!low!
Manual!Skills! o!!high! o!!average! o!!low!
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HOW*WOULD*YOU*RATE*YOUR*INTEREST*IN*THE*FOLLOWING:**Operating!Power!Tools! o!!high! o!!average! o!!low!
Drawing!Blueprints! o!!high! o!!average! o!!low!
Repairing!Equipment! o!!high! o!!average! o!!low!
Working!on!Motors! o!!high! o!!average! o!!low!
Making!Simple!Electrical!Repairs! o!!high! o!!average! o!!low!
Making!Simple!Plumbing!Repairs! o!!high! o!!average! o!!low!
Repairing!Furniture! o!!high! o!!average! o!!low!
Using!Carpentry!Tools! o!!high! o!!average! o!!low!
Building!a!Bench! o!!high! o!!average! o!!low!
Playing!with!LEGOS! o!!high! o!!average! o!!low!
Refinishing!Furniture! o!!high! o!!average! o!!low!
Painting!a!Room! o!!high! o!!average! o!!low!
Working!Outdoors! o!!high! o!!average! o!!low!
Fishing! o!!high! o!!average! o!!low!
Hunting!Game! o!!high! o!!average! o!!low!
Solving!Math!Problems! o!!high! o!!average! o!!low!
Solving!Physics!Problems! o!!high! o!!average! o!!low!
Playing!Team!Sports! o!!high! o!!average! o!!low!
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PLEASE*READ*CAREFULLY*AND*SIGN**I!certify!that!all!statements!contained!herein!are!correct!and!complete.!
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Signature! ! Date!
!Mail(the(completed(application(to:(APHCC(of(Alabama,(P.O.(Box(36972,(Birmingham,(AL(35236(
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Employer*Acceptance*Agreement**The!foregoing!undersigned!employer!hereby!subscribes!to!the!provisions!of!the!Apprenticeship!
Standards!formulated!and!registered!by!the!Associated!Plumbing!–!Heating!–!Cooling!
Contractors!of!Alabama.!__________________________!!(name!of!employing!company)!agrees!
to!carry!out!the!intent!and!purpose!of!said!Standards!and!abide!by!the!rules!and!decisions!of!
the!APHCC!of!Alabama!established!under!these!Apprentice!Standards!and!do!hereby!request!
certification!to!train!apprentice!under!the!provisions!of!these!Standards,!with!all!attendant!
rights!and!benefits!thereof,!until!cancelled!voluntarily!or!revoked!by!the!sponsor!or!Registration!
Agency.!On;the;job,!the!apprentice!is!hereby!guaranteed!assignment!to!a!skilled!and!
competent!journey!worker!and!is!guaranteed!that!the!work!assigned!to!the!apprentice!will!be!
rotated!so!as!to!ensure!training!in!all!phases!of!work.!The!employer!further!agrees!to!accept!for!
the!employment!apprentices!who!are!recommended!by!him!or!her!and!fulfill!the!requirement!
of!apprenticeship!to!the!extent!appropriate!employment!opportunities!are!available.!
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! Signed:!________________________________! Date:!____________!
! Title:!__________________________________!
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Name!of!Company:!______________________________________________________________!
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Address:!_______________________________________________________________________!
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City,!State!ZIP:!__________________________________________________________________!
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Phone,!FAX,!Email:!_______________________________________________________________!
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Disposition:!
! Original:!APHCC!of!Alabama!
! Copies:!Employer,!Registration!Agency! !