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Fairfield County Water Wastewater Management Pre-apprenticeship Program Application

Please return completed application via email to workforcecenter@fairfieldcountyohio.gov or drop off in-person at 4465 Coonpath Rd., NW, Carroll Ohio 43112 between the hours of 8:00 am – 4:00 pm, Monday – Friday.

APPLICANT INFORMATION

Last Name

First Name

Middle Name

Mailing Address

City

State

Zip Code

Phone Number

Email Address

Birthdate

EMERGENCY CONTACT

Contact Name

Phone Number

Relationship to Applicant

EDUCATION & BACKGROUND

Highest Level of Education Completed (check one):

High School Diploma / GED

Associate Degree or Higher

Some College / Trade School

None of the above

Prior Experience or Training in the Trade:

Do you require any physical or learning accommodations during training?

Yes (Please describe):

ACKNOWLEDGMENTS & PERMISSIONS

Please initial to acknowledge the following statements:

Background Check: I understand that some partner employers and work sites require a criminal background check prior to placement. I acknowledge that I can pass a criminal background check.Initial box, initial by hand after printing.

Attendance Policy: I understand that pre-apprenticeship programs have strict attendance and safety rules to prepare participants for Registered Apprenticeship Programs. I will follow the attendance policy and safety rules set forth by my instructor.Initial box, initial by hand after printing.

Drug Test: I understand that some partner employers will require a drug test before hiring. I acknowledge that I can pass a drug test.Initial box, initial by hand after printing.

Photos: Fairfield County Workforce Center has permission to take photographs and/or videos of me to be used for marketing/social media purposes.Initial box, initial by hand after printing.

Applicant Signature: Date: