ETA Form 671, Part Apprenticeship Agreement Apprentice Registration

ETA Form 671, Part II - Apprenticeship Agreement and Apprentice Registration OMB Control No. 1205-0NEW

Expiration Date: xx/xx/xxxx

ETA Form 671, Part II - Apprenticeship Agreement and Apprentice Registration

PLEASE NOTE: The Standards of Apprenticeship and work process schedule (including the Related Instruction outline) for the apprenticeship program covered by this agreement are incorporated into this agreement and are attached.  

Section A. APPRENTICE INFORMATION
1.First Name	2. Middle Initial (Optional)		3. Last Name
4. Suffix (Optional)	5. Date of Birth		6. Social Security Number*
7. Address
8. City	9. State		10. Zip Code
11. Telephone Number		12. Email Address
13. Gender Male Female Non-Binary Participant Did Not Self Identify		14. Ethnicity Hispanic or Latino Not Hispanic or Latino Participant Did Not Self Identify
15. Race (Select All That Apply) American Indian/Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander White Participant Did Not Self Identify
16. Veteran Status Non-Veteran Veteran Non-Veteran, Other Eligible Individual Veteran, Eligible Participant Did Not Self Identify		17. Educational Level at Program Entry Not a High School Graduate High School Graduate (including equivalency) Some College Associate’s Degree Bachelor’s Degree Master’s Degree Doctorate Degree
18. Employment Status New Employee Current Employee

Section B. PRE-APPRENTICESHIP INFORMATION
1a. Did the apprentice participate in a pre-apprenticeship program prior to participating in a Registered Apprenticeship program? Yes No 1b. If yes, does the pre-apprenticeship program have a documented partnership with the Registered Apprenticeship program? Yes No
2. Pre-Apprenticeship Program Name
3. Address
4. City	5. State	6. Zip Code

Section C. SUPPORTIVE SERVICES INFORMATION
1. Does this program provide registered apprentices with supportive services during the program? Yes No If Yes, proceed to item C2.     If No, proceed to Section D	2. Supportive services available to registered apprentices during the program, whether funded by the sponsor or another source. (Select All That Apply) Transportation Tools, Supplies or Uniforms Child/Dependent Care Needs-Related Payments Housing Other ___________

Section D. PROGRAM SPONSOR’S INFORMATION
1.Program Number						2. Program Sponsor’s Name
3.Program Sponsor’s Address
4. City			5. State			6. Zip Code		7. County
8. Telephone Number			9. Cell Phone Number			10. Email Address
11. Program Sponsor’s Principal Place of Business Address (if different from the sponsor’s address above)
12. Employer’s Name, Address and Contact Information (if different from the sponsor’s address above)
13. Individual Designated by the Program Sponsor to Receive Complaints
a. Name (First, MI, Last)			b. Telephone Number			c. Email Address
d. Address
e. City			f. State			g. Zip Code
14. Sponsor Occupation Title			15. Occupation O*NET Code: RAPIDS Code:
16. Term Length (hours) Duration of on-the-job training (OJT) (in hours) Duration of related instruction (RI) (in hours)			17. Probationary Period (hours)
18. Apprenticeship Start Date: __/__/____			19. Apprenticeship Expected Completion date: __/__/____
20. Beginning date of OJT __/__/____			21. Beginning date of RI __/__/____
22. Advanced Standing Policy - Explain how the usual terms or duration of the program’s on-the-job training and related instruction will be reduced (a) as a result of the apprentice's prior learning, training, or experience; or (b) as a result of accelerated attainment of occupational competencies. § 29.9(c)(16)
23a. Advanced standing and credit granted for previous OJT experience (hours)	23b. OJT term remaining (hours)				23c. Advanced standing and credit granted for previous RI (hours)
24. Are any interim credentials offered? Yes No
25. If applicable, describe any recognized postsecondary credits, credentials, and occupational qualifications that the apprentice will receive or be eligible to receive upon successful program completion. § 29.9(c)(12)
26. If applicable, indicate any additional conditions or requirements that the apprentice must fulfill to satisfy any applicable Federal, State, or local qualification and licensure requirements to engage in the occupation. § 29.9(c)(12)
27. Describe the program’s process and frequency of regularly assessing and providing feedback to apprentices on the acquisition of job-related knowledge, skills, and competencies during the on-the-job component of the apprenticeship. § 29.9(c)(9)
28. Explain the program’s end-point assessment process for certifying the apprentice's attainment of relevant occupational knowledge, skills, and competencies at the close of the apprenticeship program. § 29.9(c)(9)
29. Does the program involve any unreimbursed cost and fees for apprentices? § 29.9(c)(11) Yes No If yes, list all such costs, fees, or expenses, along with a brief description and approximate amount for each:
30. Related Instruction Provider’s Name and Address
31. Wages Paid During Related Instruction § 29.9(c)(14) Yes No If Yes, Enter Wage Amount:
32. Hours When Related Instruction is Provided During Work Hours Not During Hours Both During and Not During Work Hours
33. Journeyworker Entry Wage	34. Apprentice Entry Wage					35. Apprentice Final Wage
36. Wage Rate (Select One) % of Journeyworker Entry Wage $ amount of wage Both % and $ amount of wage
37. Wage Progression Schedule
a. Wage Progression Step		b. Hourly Wage/ % of Journeyworker Entry Wage (If Applicable)		c. Duration (If Applicable)			d. Number of Competencies (If Applicable)
1.)
2.)
3.)
4.)
5.)
6.)
7.)
8.)
9.)
10.)
38. Fringe Benefits [if applicable] a. Does the sponsor or any participating employer provide fringe benefits to apprentices? (Select One) Yes No b. If yes, please select any fringe benefits that apply: Health Insurance Contribution Life Insurance Pension/Retirement Contribution Vacation Sick Leave Paid Holidays Other “bona fide” fringe benefits:______________ If yes to item 38a above, please provide an approximate hourly value of the total fringe benefits provided.      

Section E. ADDITIONAL TERMS AND CONDITIONS OF THE AGREEMENT

1. Provide any additional terms and conditions of the apprenticeship agreement that outline or describe the respective roles, duties, and responsibilities of the apprentice, the program sponsor, and the participating employer, if applicable, during the Registered Apprenticeship program. § 29.9(c)(5).

2. Does this program require apprentices to sign a nondisclosure agreement as a condition for participating in the program?

Yes No

If yes, please affirm that the scope of the nondisclosure provision is limited to preventing the disclosure of trade secrets or confidential business information (as required by 29 CFR § 29.9(e)) by checking the box below.

I affirm.

Section F. ATTESTATIONS, AFFIRMATIONS, AND SIGNATURES

Please review the statements and mark the check boxes acknowledging agreement.

The apprenticeship sponsor, or a participating employer in the sponsor’s program, will not include in the apprenticeship agreement or otherwise impose on apprentices a non-compete clause or other similar provision that restricts an apprentice’s labor market mobility, including a provision restricting the apprentice’s ability to seek or accept employment with another employer prior to the completion of the apprenticeship program. § 29.9(d)

The apprenticeship sponsor, or a participating employer in the sponsor’s program, has provided the apprentice information regarding their rights and protections under Federal, State, and local laws, including their right to file complaints with the applicable Registration Agency and the process for doing so. § 29.9(c)(5)

The program sponsor has provided a copy of the Standards of Apprenticeship to the apprentice.

The program sponsor’s Standards of Apprenticeship, which the sponsor certifies are in accord with the requirements for program registration contained in 29 Code of Federal Regulations (CFR) parts 29 and 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 Standards of Apprenticeship 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 accord with the requirements for program registration contained in 29 CFR parts 29 and 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.

During the probationary period of the apprenticeship, this 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 or the recognized State Apprenticeship Agency.

SIGNATURES:

Apprentice Signature	Date		Parent/Guardian Signature (if < 18)		Date
Sponsor’s Representative Signature	Date		Sponsor’s Representative Signature		Date
Employer’s Representative Signature	Date		Employer’s Representative Signature		Date
Section G. TO BE COMPLETED BY REGISTRATION AGENCY
Name		Address
Signature		Date		5. Apprentice ID Number

NOTE: The collection and maintenance of the data on ETA Form 671, Part I “Apprentice Agreement and Apprentice Registration” form, is authorized under the National Apprenticeship Act, 29 U.S.C. 50, and 29 CFR part 29. 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 Business Process Model System (BPMS)(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.

ETA Form 671, Part II – Apprenticeship Agreement and Apprentice Registration Glossary

Section A: Apprentice Information

A14. Ethnicity:

• Hispanic or Latino means 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.”

A15. Race:

• American Indian or Alaska Native means 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 means 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/African American means 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/Other Pacific Islander means 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 means 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.

A16. Veteran Status:

• Non-Veteran means a person who has never served in the armed forces.

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

• Non-Veteran, Other Eligible Individual means 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.

• Veteran, Eligible means 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.

Section B: Pre-Apprenticeship Information

B1. Pre-Apprenticeship Program means a structured education and workplace training program that maintains a documented partnership with at least one registered apprenticeship program, is designed to support access and equitable participation in apprenticeship programs by providing individuals who do not currently possess the minimum qualifications for admission into a registered apprenticeship program or registered CTE apprenticeship with the foundational knowledge and skills needed to gain acceptance into, and succeed in, a registered program, and provides participants with a hands-on introduction to the competencies and techniques used in one or more occupations that are suitable for registered apprenticeship training, with access to educational and career counseling and other supportive services, and may include opportunities to earn industry-recognized credentials.

Section C: Supportive Services Information

C1. Supportive Services means services such as transportation, child care, dependent care, housing, and needs-related payments that are necessary to enable an individual to participate and succeed in registered apprenticeship and registered CTE apprenticeship.

Section D: Program Sponsor’s Information

D1. Program Number means 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).

D2. Sponsor means any person, employer, association, committee, intermediary, agency, or organization operating an apprenticeship program and in whose name the program is (or is to be) registered or approved.

D12. Employer means any person or organization that employs an apprentice during the on-the-job training component of an apprenticeship program pursuant to a program sponsor’s approved set of standards of apprenticeship and the apprenticeship agreement. If the program sponsor is different than the employer that employs the apprentices, list the employer’s name and contact information.

D14. Sponsor Occupation Title means the occupation an apprentice will be trained in; such occupation will be listed in the sponsor’s program standards.

D15a. Occupational Information Network (O*NET) Code means the 8-digit code in the O*NET data system (https://www.onetonline.org/).

D15b. RAPIDS Code means the numeric code of the occupation in the list of occupations deemed suitable for apprenticeship training.

D16. Term Length means the hourly duration of on-the-job training and related instruction contained in the approved Standards of Apprenticeship for the Registered Apprenticeship program.

D17. Probationary Period means the number of hours or weeks of on-the-job training 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.

D23a. Credit Granted for Previous On-the-Job Training (OJT) Experience means the number of hours granted by the program sponsor based upon documented evidence previous OJT provided by the apprentice.

D23b. OJT Term Remaining means the resulting term length of the on-the-job training after the granting of credit for previous training or work experience.

D23c. Credit Granted for Previous Related Instruction (RI) Experience means the number of hours granted by the program sponsor based upon documented evidence previous RI provided by the apprentice.

D24. Interim Credential means a recognized postsecondary credential issued in connection with participation in a registered apprenticeship program. The interim credential may signify that an apprentice has successfully attained competency milestones within an occupation deemed suitable for registered apprenticeship training, usually as a part of a career pathway, sequence, or progression towards the attainment of more advanced competencies and credentials in that occupation.

D25. Recognized Postsecondary Credential means a credential consisting of an industry-recognized certificate or certification, a Certificate of Completion, a license recognized by the State involved or Federal Government, or an associate or baccalaureate degree.

D29. Costs, Fees or Expenses means any costs, fees, or expenses relating to participation in the on-the-job

training or related instruction components of an apprenticeship program that apprentices may be obligated

to assume (either explicitly or implicitly). For purposes of this registration form, sponsors must list each

cost, fee, or expense, including a brief description of each and the approximate or average amount of the

cost, fee, or expense. Examples of costs, fees, and expenses assumed by apprentices include equipment,

supplies, assessments, licensures, or other costs necessary for the successful completion of the on-the-job

training and related instruction components of the apprenticeship program.

D31. Wage Amount means the hourly wage amount paid during related instruction.

D33. Journeyworker Entry Wage means the initial wage paid to an individual after they complete the

apprenticeship, calculated as dollars per hour.

D34. Apprentice Entry Wage means the hourly wage paid to an apprentice at program entry, calculated as

dollars per hour.

D35. Apprentice Final Wage means the hourly wage paid to an apprentice during their final progression in

the wage schedule, calculated as dollars per hour. The apprentice final wage must be at least 75 percent of the journeyworker entry wage.

D36. Wage Rate means either the percent of journeyworker (i.e., experienced worker) wage, the 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.

D37. Wage Schedule Information means the requirement of a progressively increasing schedule of wages during the apprenticeship based on the acquisition of increased skills and occupational competencies on the job and in related instruction.

D38. Fringe Benefits means, where applicable, sponsor or participating employer contributions irrevocably made to a trustee or third party pursuant to a bona fide fringe benefit fund plan or program; and/or the rate of costs incurred in providing bona fide fringe benefits pursuant to an enforceable commitment to carry out a financially responsible plan or program, which was communicated to the apprentices in writing. However, payments required by federal, state, or local law are not fringe benefit contributions; accordingly, payments required to fund Social Security, unemployment compensation and workers’ compensation programs, as required by law, do not count as fringe benefits. For more information, visit: https://www.dol.gov/agencies/whd/government-contracts/construction/faq/fringe-benefits.

Section G: To Be Completed by Registration Agency

G5. 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.

Public Burden Statement: 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 ten 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 or email [email protected] and reference OMB Control Number 1205-0NEW. Note: Please do not return the completed ETA Form 671, Part II to this address.

**An apprentice’s disclosure of their social security number is voluntary. The Department of Labor collects apprentice social security numbers under the authority of the National Apprenticeship Act. 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, which 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.

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