CEPAP Application Pre-Apprenticeship Application Your Personal InformationYour Name(Required) First Middle Last Your Email Address(Required) Enter Email Confirm Email Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone number(Required)Gender(Required) Male Female Do not identify Prefer not to say Race/Ethnicity(Required) American Indian or Alaskan Native Asian or Pacific Islander Black Hispanic White Other What is your date of birth?(Required) MM slash DD slash YYYY Citizenship(Required) United States Citizen Resident Alien Refugee If not a US Citizen, what is the expiration of your valid work visa? MM slash DD slash YYYY Educational HistorySelect highest level of schooling that you have completed.(Required) High School Diploma GED/High School Equivalency Trade/Technical School Some College, No Degree Associates Degree (2-year) Bachelors Degree (4-year) Masters Degree and above Other post-secondary Training Employment HistoryAre you a United States Military Veteran? Yes No If yes, upload a copy of your military DD-214 form.Upload your document in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Are you currently employed?(Required) Yes No Current EmployerPlease list the name of your current employer, the date you started and the position you hold.EmployerDatesPosition Add RemovePrevious EmployerPlease list your previous employer, the dates you worked and the position you held.EmployerDatesPosition Add RemovePrevious EmployerPlease list your previous employer, the dates you worked and the position you held.EmployerDatesPosition Add RemoveHave you ever completed a building trade Pre-apprenticeship Program?(Required) Yes No If yes, what was the name of the program and year completed?Why do you want a career in the clean energy electrical sector and what makes you a good candidate for this work?(Required)Required Supporting DocumentationUpload a copy of Diploma, GED or HiSET. Foreign documents must be translated into English by a certified translation service.(Required)Upload your document in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Upload proof of identity.(Required)Upload one of the following items: • US Passport or Permanent Resident Card or Alien Registration Receipt Card (Form 1-551) • Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address • ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address • School ID card with a photograph Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Upload proof of employment authorization.(Required)Upload one of the following items: • US Passport or Permanent Resident Card or Alien Registration Receipt Card (Form 1-551) • Social Security Account Number card • Certification of Birth Abroad issued by the Department of State (Form FS-545) • Certification of Report of Birth issued by the Department of State (Form DS-1350) • Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal • Native American tribal document • Identification Card for Use of Resident Citizen in the United States (Form 1-179) • Employment authorization document issued by the Department of Homeland SecurityAccepted file types: pdf, doc, docx, Max. file size: 25 MB. Upload proof of age.(Required)Upload any of the government-issued documents listed above, provided it contains your date of birth.Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Terms and Conditions(Required)Applicants to this program agree to the following terms and conditions: 1. I am physically capable of performing electrical work. 2. I agree to submit to drug testing. I agree to the terms and conditions.Applicant Certification(Required)I certify that my answers on this Application are true and complete to the best of my knowledge. I understand that if the information provided leads to admission into the Clean Energy Pre-Apprenticeship Program, false or misleading information may result in my release. I authorize the Greater Boston JATC to share this information with program funders. I release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. You are hereby authorized to make any investigation of my personal history, academic/professional credentials, military service records, through any investigative or credit bureaus of your choice. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I agree to the above statement.Date MM slash DD slash YYYY