Form Aic-589 - Apprenticeship Information Center Application printable pdf download

APPRENTICESHIP INFORMATION CENTER APPLICATION

COMPLETE, PRINT OUT AND E-MAIL SCANNED ATTACHMENT TO

patrick.durkin@illinois.gov

OR FAX TO 312-793-1778.

Social Security Number: (last 4 only) ________________________

Today’s Date: ___________________

Last Name: _________________________________

First: _________________________ M: _____________

Mailing address: __________________________________________ Apt: (Optional) __________________

City: ___________________________ County: _________________________ State: _____ Zip code: __________

Phone: ______________________ Date of birth: _________________

Male: _____ Female: _____

E-mail: ___________________________________________ Legally authorized to work in the US? Yes: __ No: __

Are you currently in school? Yes: _____ No: _____

Highest grade of school completed: Grades (1-12): _____

HS diploma or GED: _____

College degree: _____

Which best describes your ethnic background? (For statistical purposes only):

1. White ___ 2. Black ___ 3. Hispanic ___ 4. Native American ___ 5. Pacific Islander/Asian ___ 6. Other ___

Do you have a driver's license? Yes: ___ No: ___

Are you currently working? Yes: ___ No: ___

What skilled crafts would you pursue in apprenticeship training? Go to the IDES Web site at

Then to the orange Individuals bar > Search for Jobs > Special Programs > Apprenticeship. Scroll to the bottom of the

page to visit statewide trade links for a variety of information about each. Choose up to 4 crafts from these links.

l. ____________________ 2. ____________________ 3. __________________ 4. ____________________

Many apprenticeship programs require travel to different work sites. In what county/counties would you be willing,

able, and available to work in?

l. ____________________ 2. ____________________ 3. __________________

<<<<<<< Be sure to register at

for all other job opportunities >>>>>>>

Veterans: lf you served in the US Armed Forces or are a spouse of a veteran, please complete this section:

Have you served on active duty in the U.S. Armed Forces for more than 181 days for other than training for the National

Guard or Reserve? Yes: ___ No: ___

Have you served as a National Guard or Reservist ordered to active duty during a period officially defined as a war or in a

campaign or expedition for which a campaign badge is authorized? Yes: ___ No: ___

Are you the spouse of a Veteran? Yes: ___ No: ___

User form AIC-589 (Rev. 5/2/16)

Stock No. 6021 II 427-0412

Form Aic-589 - Apprenticeship Information Center Application