The Virginia Apprentice Action Form serves as a crucial document within the Commonwealth's apprenticeship program, facilitating the registration and monitoring of apprentices. This form not only collects essential information about the apprentice but also ensures compliance with various legal standards aimed at promoting equal opportunity in the workforce. By gathering data on race, gender, and veteran status, the Virginia Department of Labor and Industry aims to enhance diversity and inclusion in apprenticeship training programs.
The Virginia Apprentice Action form plays a crucial role in the apprenticeship program administered by the Commonwealth of Virginia's Department of Labor and Industry. This form is designed to facilitate the registration of apprentices while ensuring compliance with various regulations and standards. It collects essential information about the apprentice, including their name, contact details, and demographic data, which is used for statistical analysis by state and federal labor departments. Notably, the form emphasizes non-discrimination, requiring sponsors to adhere to Equal Opportunity Standards in selecting and training apprentices. Additionally, it outlines the terms of the apprenticeship agreement, including the probation period, wage structure, and educational requirements. The form also provides a mechanism for both parties to terminate the agreement if necessary. By completing this form, apprentices and sponsors can establish a clear understanding of their rights and responsibilities within the apprenticeship program.
COMMONWEALTH OF VIRGINIA APPRENTICESHIP PROGRAM DEPARTMENT OF LABOR AND INDUSTRY 13 S. 13TH STREET
RICHMOND, VIRGINIA 23219
APPRENTICE ACTION FORM
FIELD REP LAST NAME/#
SPONSOR NO
In accordance with the Privacy Protection Act of 1973, Sections 2.1-377-386 of the Code of Virginia, you are not legally required to complete this request for information concerning your race or sex or veteran status. This information is used by the Virginia Department of Labor and Industry and the U.S. Department of Labor for statistical analysis to determine the percentage of minorities, women, and veterans that participate in apprenticeship training. However, if you are applying for Veterans Administration (VA) benefits, you must indicate that you are a veteran.
The program sponsor and apprentice agree to the terms of the Apprenticeship Standards incorporated as part of this Agreement. The sponsor will not discriminate in the selection and training of the apprentice in accordance with the Equal Opportunity Standards in Title 29 CFR Part 30.3 and Executive Order 11246. This agreement may be terminated by either of the parties, citing cause(s), with notification to the registration agency, in compliance with Title 29, CFR, Part 29.6
Apprentice Name: (Type or print name as it should appear on completion certificate)
First Name
Middle Initial
Last Name
Address
City
VA
Zip Code
Phone
SSN
Sex
Occupation
Date of Birth
Veteran
DOT/O*NET Code
Race
Credit
Length of Program
Hours - Probation
Hours
Starting Date
Education Level
Estimated Completion Date
Name & Location Where Attained (If Credit Given)
Previously Registered as an apprentice with the State of Virginia only?
Yes
No
Name of company/sponsor?
Related Instruction will be covered through
Related Instruction
Apprentice Wages For Related Instruction
(Number Hours Per Year)
Will Be Paid
Will Not Be Paid
Competency
X
Time Based
Hybrid
Signature of Apprentice
Date
Signature of Parent/Guardian (if minor)
Sponsor
Name of Sponsor Representative
City/County
FIPS
State
Fax
Email
PLEASE CHECK IF THIS IS A
REGISTRATION
SUPERSEDING AGREEMENT
REINSTATEMENT
STUDENT (H.S. CODE)
COMMUNITY COLLEGE CODE
Journeyworker's Hourly Wage $
Apprentice's Entry Hourly Wage $
WAGES
Term
Period 1
2
3
4
5
6
7
8
9
10
(Hrs)
Wage Rate
$
(Mark One) %
Signature of Sponsor's Representative
Date Signed
Name and Address of Sponsor Designee to Receive Complaints (if applicable)
Registered with the Virginia Department of Labor and Industry
Commissioner
COMPLETION Additional Credit Hours at time of Completion
(2,000 hours or more a letter is required)
Title
Signature of Related Instruction Coordinator
CANCELLATION
EFFECTIVE DATE
Reason
Revised 2011
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