Form ETA 671 ETA 671 Program Registration and Apprenticeship Agreement

Program Registration and Apprenticeship Agreement		U.S. Department of Labor E mployment and Training Administration Office of Apprenticeship
APPRENTICE AGREEMENT AND REGISTRATION – SECTION II OMB No. 1205-0223 Expiration Date: XX/XX/XXXX
PART A: APPRENTICE’S INFORMATION
1. First Name Last Name             Middle Name (Optional) Suffix (Optional)             Address (No., Street, City, State, Zip Code)       Telephone Number (Optional) E-mail Address (Optional)             *Social Security Number    -  -     		Answer Both 4a. and 4b. below 4. a. Ethnicity (Select One) Hispanic or Latino Not Hispanic or Latino Participant Did Not Self-Identify b. Race (Select One or More) American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Participant Did Not Self-Identify			5. Veteran Status (Select All That Apply) Non Veteran Veteran Non Veteran, Other Eligible Individual Veteran, Eligible Participant Did Not Self-Identify
					6. Education Level (Select One) Not High School graduate High School graduate (including equivalency) Some College or Associate’s degree Bachelor's degree Master’s degree Doctorate or professional degree
2. Date of Birth (Mo., Day, Yr.)      	3. Sex (Select One) Male Female Participant Did Not Self-Identify
7. Employment Status of Apprentice (Select One) New Employee Current Employee
8. Did the apprentice complete a pre-apprenticeship program prior to their registration in this apprenticeship program? Yes No If yes, please provide the Pre-Apprenticeship Program Name and Address:      
PART B: PROGRAM SPONSOR’S INFORMATION
1. Program Number       Sponsor’s Name and Address (No., Street, City, State, Zip Code, County)       Telephone Number Cell Phone Number (Optional)             E-mail Address       a. Sponsor’s Principal Place of Business Address (If different from Sponsor’s address above)       b. Employer’s Name and Address (If different from Sponsor’s address above)      		2. Occupation (The work processes listed in the standards are part of this agreement.)       RAPIDS Code:       O*NET Code:       Interim Credentials Offered (i.e., Career Lattice Occupation)? Yes No
		3. Occupation Type (Select One) a. Time-based b. Competency-based c. Hybrid	4. Term Length (Hrs., Mos., Yrs.)      			5. Probationary Period (Hrs. or Wks.)      
		6. Credit for Previous On-the-Job Learning Experience (Hrs. Mos., Yrs.):      a. Term Remaining (Hrs., Mos., Yrs.)      		7. Credit for Previous Related Instruction Experience (Hrs., Mos., Yrs.)      			8. Date Apprenticeship Begins       a. Expected Completion Date      

9. Related Instruction Provider(s) Name and Address      

a. Total Length of Related Instruction      

b. Are Wages Paid During Related Instruction? Yes No

c. Hours When Related Instruction Is Provided During Work Hours Not During Work Hours Both During and Not During Work Hours

10. Progressive Wage Schedule:

a. Apprentice’s Entry Wage $      b. Journeyworker’s (i.e., Experienced Worker’s) Wage $     

Period

1

2

3

4

5

6

7

8

9

10

c. Wage Rate Units

Duration (If Applicable)

     

     

     

     

     

     

     

     

     

     

Competencies (If Applicable)

     

     

     

     

     

     

     

     

     

     

d. Wage Rate (Select One) % of Journeyworker (i.e., Experienced Worker) wage $ amount of wage Both % and $ amount of wage

Wage Rate

     

     

     

     

     

     

     

     

     

     

11. Name and Contact Information of the Individual Designated by the Program Sponsor to Receive Complaints      

PART C: AGREEMENT AND SIGNATURES
The program sponsor’s Apprenticeship Standards, which the sponsor certifies are in conformity with the requirements for program registration contained in 29 Code of Federal Regulations (CFR) part 29, subpart A and 29 CFR part 30, are attached and are hereby incorporated into this agreement. The program sponsor and apprentice hereby agree to the terms of the Apprenticeship Standards that are incorporated as part of this agreement, as those Standards existed on the date of the agreement. These Apprenticeship Standards may be amended during the period of this agreement with the consent of the parties to the agreement, provided that such amendments are also in conformity with the requirements for program registration contained in 29 CFR part 29, subpart A and 29 CFR part 30. The apprentice will be accorded equal opportunity in all phases of apprenticeship employment and training by the program sponsor, without discrimination because of race, color, religion, national origin, sex (including pregnancy and gender identity), sexual orientation, age (40 or older), genetic information, or disability. This agreement may be canceled by either of the parties, citing cause(s), with written notice to the registration agency, in compliance with 29 CFR part 29, subpart A. During the probationary period described in Part B above, this apprenticeship agreement may be cancelled by either party upon written notice to the registration agency. After the probationary period, this agreement may be cancelled at the request of the apprentice, or suspended or cancelled by the sponsor, for good cause, with due notice to the apprentice and a reasonable opportunity for corrective action, and with written notice to the apprentice and to the Registration Agency of the final action taken. This apprenticeship agreement does not constitute a certification under 29 CFR part 5 for the employment of the apprentice on Federally financed or assisted construction projects. Current certifications must be obtained from the Office of Apprenticeship (OA) or the recognized State Apprenticeship Agency.
1. Signature of Apprentice Date            		2. Signature of Parent/Guardian (If minor) Date            
3. Signature of Sponsor’s Representative(s) Date            		4. Signature of Sponsor’s Representative(s) Date            
5. Signature of Employer’s Representative(s) Date (If Applicable)            		6. Signature of Employer’s Representative(s) Date (If Applicable)            
PART D: TO BE COMPLETED BY REGISTRATION AGENCY
1. Registration Agency and Address      	2. Signature (Registration Agency)      		3. Date Registered      
4. Apprentice Identification Number:      

NOTE: The collection and maintenance of the data on ETA-671, Apprentice Agreement and Registration – Section II Form, is authorized under the National Apprenticeship Act, 29 U.S.C. 50, and 29 CFR part 29, subpart A. The data is used for apprenticeship program statistical purposes and is maintained, pursuant to the Privacy Act of 1974 (5 U.S.C. 552a), in a systems of records entitled, DOL/ETA-31, The Enterprise Business Support System (EBSS) (encompassing RAPIDS), at the U.S. Department of Labor, Office of Apprenticeship. Data may be disclosed to Federal, state, and local agencies and community-based organizations, including State Apprenticeship Agencies, to facilitate statistical research, audit, and evaluation activities necessary to ensure the success, integrity, and improvement of employment and training programs. Data may also be disclosed to these organizations to determine an assessment of skill needs and program information, and in connection with federal litigation or when required by law.

Definitions / Instructions

Part A: Apprentice’s Information

Item 4a. Ethnicity

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, “Spanish origin,” can be used in addition to “Hispanic or Latino.”

Item 4b. Race

American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. This category includes people who indicate their race as "American Indian or Alaska Native" or report entries such as Navajo, Blackfeet, Inupiat, Yup'ik, or Central American Indian groups or South American Indian groups.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. This includes people who reported detailed Asian responses such as: "Asian Indian," "Chinese," "Filipino," "Korean," "Japanese," "Vietnamese," and "Other Asian" or provide other detailed Asian responses.

Black or African American: A person having origins in any of the Black racial groups of Africa. It includes people who indicate their race as "Black or African American," or report entries such as African American, Kenyan, Nigerian, or Haitian.

Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. It includes people who reported their race as "Fijian," "Guamanian or Chamorro," "Marshallese," "Native Hawaiian," "Samoan," "Tongan," and "Other Pacific Islander" or provide other detailed Pacific Islander responses.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who indicate their race as "White" or report entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or Caucasian.

Item 5. Veteran Status

A Veteran is a person who has served in the active military, naval, or air service of the United States, and who was discharged or released therefrom under conditions other than dishonorable.

A Non Veteran, Other Eligible Individual is a person who is a dependent spouse or child—or the surviving spouse or child—of a Veteran, and who is eligible for certain G.I. Bill and other VA-administered educational assistance benefits provided under Title 38 of the U.S. Code.

A Veteran, Eligible is a Veteran who is eligible for certain G.I. Bill and other VA-administered educational assistance benefits provided under Title 38 of the U.S. Code.

Item 8.

Pre-Apprenticeship: A program or set of strategies designed to prepare individuals to enter and succeed in a Registered Apprenticeship program and has a documented partnership with at least one, if not more, Registered Apprenticeship program(s).

Part B: Program Sponsor’s Information

Item 1. A Program Number is a generated number assigned to a program sponsor when a program is registered in the Office of Apprenticeship’s Registered Apprenticeship Partners Information Data System (RAPIDS).

Item 1. A Sponsor Name is any person, association, committee, or organization operating an apprenticeship program and in whose name the program is (or is to be) registered or approved.

Item 1b. An Employer is any person or organization employing an apprentice whether or not such person or organization is a party to an Apprenticeship Agreement with the apprentice.

Item 2. An Occupation refers to the occupation an apprentice will be trained in, and the occupation will be listed in the sponsor’s program standards.

Item 2a. A RAPIDS Code is the numeric code of the occupation in the apprenticeable occupation list.

Item 2b. An Occupational Information Network (O*NET) Code is an 8-digit code in the O*NET data system (https://www.onetonline.org/).

Item 2c. Interim Credentials (Certificate of Training) applies to career lattice occupations. These credentials are issued by the Registration Agency upon request by the program sponsor. Interim credentials provide certification of competency attainment by an apprentice, but does not necessarily indicate completion of the program.

Item 3. Occupation Type refers to the following three training approaches listed below.

Item 3a. A Time-based Approach measures skill acquisition through the individual apprentice’s completion of at least 2,000 hours of on-the-job learning as described in a work process schedule.

Item 3b. A Competency-based Approach measures skill acquisition through the individual apprentice’s successful demonstration of acquired skills and knowledge, as verified by the program sponsor. Programs utilizing this approach must still require apprentices to complete an on-the-job learning component of Registered Apprenticeship. The program standards must address how on-the-job learning will be integrated into the program, describe competencies, and identify an appropriate means of testing and evaluation for such competencies. An apprentice must be registered in an approved competency-based occupation for 12 calendar months of on-the-job-learning.

Item 3c. A Hybrid Approach measures the individual apprentice’s skill acquisition through a combination of specified minimum number

of hours of on-the-job learning and the successful demonstration of competency as described in a work process schedule.

Item 4. A Term Length (Hrs., Mos., Yrs.) of the occupation is based on the program sponsor’s training approach as approved by the

Registration Agency.

Item 5. A Probationary Period (Hrs. or Wks.) is the number of hours or weeks of on-the-job learning during the apprentice’s probationary period. A probationary period cannot exceed 25 percent of the term length of the occupation or one year, whichever is shorter.

Item 6. Credit for Previous On-the-Job Learning Experience (Hrs., Mos., Yrs.) is granted by the program sponsor based upon documented evidence provided by the apprentice. An apprentice must complete a minimum of six months on-the-job learning regardless of credits for previous experience awarded.

Item 6a. The Term Remaining (Hrs., Mos., Yrs.) is the difference between the term length of the on-the-job learning and the credits for previous experience awarded.

Item 7. Credit for Previous Related Instruction Experience (Hrs., Mos., Yrs.) is granted by the program sponsor based upon documented evidence provided by the apprentice.

Item 9a. Total Length of Related Instruction is the duration spent in related instruction in technical subjects related to the occupation, which is recommended to be not less than 144 hours per year.

Item 10. Progressive Wage Schedule:

Item 10a. Apprentice’s Entry Wage (dollar amount paid): A sponsor enters this apprentice’s entry wage.

Item 10b. Journeyworker’s (i.e., Experienced Worker’s) Wage: A sponsor enters the wage per unit (i.e., hourly, weekly, monthly, quarterly, semi-annually, or annually).

Item 10c. Wage Rate Units: A sponsor enters the apprentice schedule of pay for each advancement period based on the program sponsor’s

training approach (i.e., hourly, weekly, monthly, quarterly, semi-annually, annually, or competencies).

Item 10d. Wage Rate: Sponsor selects either percent of journeyworker (i.e., experienced worker) wage, dollar amount of wage, or both the percent of journeyworker wage and dollar amount of wage. If the sponsor selects “Both the percent of journeyworker wage and $ amount of wage,” the sponsor can enter a percentage or dollar amount for the wage in each period.

Item 11. Complaints: Identifies the individual or entity responsible for receiving complaints (29 CFR 29.7(k)).

Part D: To Be Completed By Registration Agency

Item 4. Apprentice Identification Number: RAPIDS encrypts the apprentice’s social security number and generates a unique

identification number to identify the apprentice. It replaces the social security number to protect the apprentice’s privacy.

*The submission of the apprentice’s social security number is requested. The apprentice’s social security number will be used for program management purposes, such as verification of the apprentice’s period of employment and earnings to align with Department of Labor’s job training and employment program performance indicators for measuring performance outcomes. The Office of Apprenticeship will use wage records through the State Wage Interchange System needs the apprentice’s social security number to match this number against the employers’ wage records. Also, the apprentice’s social security number will be used, if appropriate, for purposes of the Davis Bacon Act of 1931, as amended, U.S. Code Title 40, Sections 276a to 276a-7, and Title 29 CFR part 5, to verify and certify to the U.S. Department of Labor, Wage and Hour Division, that the apprentice is a registered apprentice to ensure that the employer is complying with the geographic prevailing wage of the occupational classification. Failure to disclose an apprentice’s social security number on this form will not affect the right to be registered as an apprentice. Civil and criminal provisions of the Privacy Act apply to any unlawful disclosure of social security numbers, which is prohibited.

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond is required to obtain or retain benefits under 29 U.S.C. 50. Send comments regarding this burden or any other aspect of this collection of information including suggestions for reducing this burden to the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship, 200 Constitution Avenue, N.W., Room C-5321, Washington, D.C. 20210 (OMB Control Number 1205-0223).

Page 6 of 6 ETA 671 - Section II