Apprenticeship APPLICATION FORM
1 - TRADE Trade
2 - PERSONAL INFORMATION
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 Beneficiary : 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
3 - CONTACT INFORMATION
Best method to contact me is: Telephone Email Mail
Permanent Mailing Address Mailing Address All sections are mandatory - Place a dash or line through boxes that do not apply to you.
Community Territory/Province Postal Code
Telephone (Home) Telephone (Work) Fax ( ) ( ) ( )
Telephone (Cell) Email Address ( )
1/9 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 certifications in this trade Apprentice (regular route) or NEAT (Nunavut Early Apprenticeship Program) Pre-Apprenticeship Program NAC’s Pre-Trades course or Trades Access course Certificate of Diploma courses inTrades 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 All sections are mandatory - Place a dash or line through boxes that do not apply to you. DATE CERTIFICATE / DATE STARTED COURSE OR PROGRAM INSTITUTION LOCATION COMPLETED DIPLOMA ETC. (YY - MM) (YY - MM) OBTAINED
2/9 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 ‘certified true copy’* of all supporting documentation (ex. trade certificate, diploma, credential or transcript) to your application. (* A certified copy that is a copy certified to be an exact copy of the original. A lawyer or a notary public or Commissioner of Oath can do this for you.) All sections are mandatory - Place a dash or line through boxes that do not apply to you.
3/9 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 Date Finished
YYYY-MM-DD 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 Date Finished
YYYY-MM-DD YYYY-MM-DD
Total Months Total Hours
Duties
Type of employment Full-time Full-time seasonal Part-time Other : ______
4/9 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 financail support. • The Workplace Safety and Health Branch, the Employment Standards Branch, Labour Standards Compliance Office - 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 officials responsible for apprenticeship or trade certification 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) officials to administer the Interprovincial Standards Red Seal Program and /or to confirm 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 office. • 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. All sections are mandatory - Place a dash or line through boxes that do not apply to you.
Signature of Apprentice Date (YYYY-MM-DD)
Parent/Guardian’s Signature Date (YYYY-MM-DD) (if Apprentice is under age 19)
5/9 Apprenticeship Application 7 - EMPLOYER INFORMATION (TO BE COMPLETED BY EMPLOYER) EMPLOYER INFORMATION 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
Certificate Number
Province / Territory
Postal Code
Reminder : Please attach a copy of SJP’s certificate.
WAGES
Please indicate the lowest pay rate for a newly certified journeyperson your firm would normally use in this trade:
$ ______/ h
All sections are mandatory - Place a dash or line through boxes that do not apply to you. Is your application related to any special project? Yes No Agnico Eagle Baffin Land Mines New 2013 Housing Project Iqaluit Airport Project Other: ______
Details
6/9 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:
TRADE CREDIT BALANCE OF APPRENTICESHIP INSTRUCTION EXAMINATIONS LEVEL (SUBTRACT) APPRENTICSHIP TIME REQUIRED COURSES REQUIRED TIME REQUIRED 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 certificate of qualification 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 affiliated staff to fulfill 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 verified and the recommendations above are : All sections are mandatory - Place a dash or line through boxes that do not apply to you. Approved Denied Approved with the following modifications/conditions: ______
Name of Supervisor / Registrar Signature Date (YYYY-MM-DD)
7/9 Apprenticeship Application EMPLOYER CONSENT FORM
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 Yes No general trades related correspondence, for consideration of an honour or award.
I also authorize the Unit to disclose business-identifying information as it relates to participation for the purposes of Yes No promotion of the Nunavut Apprenticeship program on the Apprenticeship Unit website.
Signature of Employer Date (YYYY-MM-DD) All sections are mandatory - Place a dash or line through boxes that do not apply to you.
8/9 Apprenticeship Application APPRENTICESHIP AGREEMENT
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 specific expenses identified 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 Officer (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 Officer (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 qualifications 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 qualified journeyperson in accordance with theApprenticeship, Trade and Occupations Certification 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 difficulties 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. All sections are mandatory - Place a dash or line through boxes that do not apply to you.
Signature of Apprenticeship Applicant Name of Apprenticeship Applicant Date (please print) (YYYY-MM-DD)
Signature of Parent/Guardian Name of Parent/Guardian Date (If Apprentice is under 19y) (please print) (YYYY-MM-DD)
Signature of Sponsoring Employer Name of Sponsoring Employer Date (please print) (YYYY-MM-DD)
9/9