Virginia Apprentice Action Form – Fill Out and Use This PDF

The Virginia Apprentice Action Form is an essential document in the administration of apprenticeship programs within the Commonwealth of Virginia, overseen by the Department of Labor and Industry. It facilitates the formalization of apprenticeship agreements, ensuring compliance with both state and federal guidelines regarding the provision of equal opportunity and the collection of demographic data for statistical analysis. Those interested in participating in an apprenticeship program are encouraged to complete this form by clicking the button below.

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Virginia Apprentice Action Form PDF Details

In the heart of Virginia's efforts to bolster its workforce through structured training programs, the Apprentice Action Form serves as a pivotal component of the Commonwealth's apprenticeship framework. Administered by the Virginia Department of Labor and Industry, located on S. 13th Street in Richmond, this document facilitates the formal aspects of registering an apprenticeship agreement between a sponsor and an apprentice. Its comprehensive design captures necessary personal details, including the apprentice's name, contact information, occupation, and demographic specifics, which, while voluntary due to the Privacy Protection Act of 1973, play a crucial role in gathering data for statistical analyses aimed at understanding demographic participation in these programs. Importantly, the form outlines the conditions under which the apprenticeship will operate, emphasizing the commitment to equal opportunity and non-discrimination as guided by federal and state regulations. Moreover, it lays out the structure of the apprenticeship, including the length, wage scale, educational components, and termination guidelines, all while offering a mechanism for veterans to identify themselves for benefits purposes. This form is not just paperwork; it is a declaration of intent, setting the stage for a structured training journey underpinned by legal and ethical standards that promise a rewarding path for aspiring tradespeople.

Question	Answer
Form Name	Virginia Apprentice Action Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	CFR, SSN, DONATI, aprehetice form

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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

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

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

Time Based

Hybrid

Signature of Apprentice

Date

Signature of Parent/Guardian (if minor)

Date

Sponsor

Name of Sponsor Representative

Address

City/County

FIPS

State

Zip Code

Phone

Fax

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

(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

Date

COMPLETION Additional Credit Hours at time of Completion

(2,000 hours or more a letter is required)

Signature of Sponsor's Representative

Title

Date

Signature of Related Instruction Coordinator

Date

CANCELLATION

EFFECTIVE DATE

Reason

Signature of Sponsor's Representative

Date

Revised 2011

Virginia Apprentice Action Form – Fill Out and Use This PDF

Virginia Apprentice Action Form PDF Details

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