Program Registration and Apprenticeship Agreement

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Program Registration and
Apprenticeship Agreement	

U.S. Department of Labor  
Employment 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 

Submission of information for questions 3-6 is voluntary and choosing not to provide this data will not subject the apprentice to adverse treatment. Information collected will only be used for lawful purposes. 


1. First Name                                                     Last Name
  	                                                                                     

Middle Name (Optional)	                             Suffix (Optional)

                                                                           

Address (No., Street, City, State, Zip Code) 

     

Telephone Number (Optional)                   E-mail Address (Optional)

	                                                                            

Date of Birth (Mo., Day, Yr.)
        

4.	 What is your race and/or ethnicity? (Select all that apply)

 Hispanic or Latino

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or 	 Pacific Islander

 White

 Middle Eastern or North African

 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

 Participant Did Not Self-Identify



2. * Social Security Number

    -  -     
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


*The submission of the apprentice’s social security number (SSN) is requested but does not affect the right to be registered as an apprentice.  The apprentice’s SSN will be used for program management purposes, such as verification of the apprentice’s period of employment and earnings to align with DOL program performance indicators. The Office of Apprenticeship uses the apprentice’s social security number to match the employer’s wage records found in the State Wage Interchange System. The apprentice’s SSN will also 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 DOL’s Wage and Hour Division, that the apprentice is registered with an employer that is complying with the geographic prevailing wage of the occupational classification. Civil and criminal provisions of the Privacy Act apply to any unlawful disclosure of social security numbers, which is prohibited.








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.)       

    a. RAPIDS Code:       

    b. O*NET Code:       

    c. 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 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 and 29 CFR part 30.  

Program sponsors must comply with all applicable Federal and State laws and regulations prohibiting illegal discrimination on the basis of race, color, religion, national origin, sex, age (40 or older), genetic information, or disability. The apprentice must not be illegally discriminated against in any phases of apprenticeship employment and training. 

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 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.  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 in connection with federal litigation or when required by law.








Definitions / Instructions

Part A: Apprentice’s Information
Item 4. Race and/or Ethnicity
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, Salvadoran, Dominican, Guatemalan, and other Central or South American, or Spanish culture or origin.
American Indian or Alaska Native: A person having origins in any of the original peoples of North, Central, and South America, including, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya.
Asian: A person having origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia, including, for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, or Japanese.
Black or African American: A person having origins in any of the Black racial groups of Africa, including, for example, African American, Jamaican, Nigerian, Ethiopian, Somali, or Haitian.
Native Hawaiian or Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including, for example, Fijian, Chamorro, Marshallese, Native Hawaiian, Samoan, and Tongan.
White: A person having origins in any of the original peoples of Europe, including, for example, English, Irish, German, Italian, Polish, or Scottish.
Middle Eastern or North African: A person having origins in any one of the original peoples of the Middle East or North Africa, including, for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli.
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.  
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.  
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.


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).