State of California IT Apprenticeship Program

Application - Part 1 of 2

Please complete all field listed below.

Please also remember that those applying must be prepared to work hard and make personal sacrifices. Apprentices should expect to attend class at least twice a week in the evenings after work and continue coursework year-round. We ask that you fully consider this commitment before applying.

As a reminder, all application materials must be submitted and received by 5:00 p.m. on Wednesday, September 9, 2020.

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* 1. Applicant Name

First

Last

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* 2. Personal Contact Information

(Please note that if providing a cell phone number, you agree that SEIU Local 1000, SEIU, and affiliates may use automated technologies and/or may text message you on your cell phone on a periodic basis. SEIU will never charge for alerts, but carrier rates may apply.)

Home Street Address

Home City and Zip Code

Personal Email Address

Home or Cell Phone Number

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* 3. Work Contact Information

Work Street Address

Work City and Zip Code

Work Email Address

Work Phone

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* 4. Supervisor Information

Supervisor Name

Supervisor Email Address

Supervisor Phone

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* 5. Date of Hire with the State of California

Date of Hire

Date

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* 6. What is your current department? (Note, if your department is not listed, it is not participating in this cohort, but may participate in future cohorts.)

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* 7. What is your current classification?

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* 8. Are you currently serving a probationary period or on a limited term assignment?

No.

Yes, I am on currently on probation.

Yes, I am currently on a limited term assignment.

If yes, what date does your probation or limited term assignment end?

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* 9. I have completed at least 3 college level semester units of IT coursework with a passing grade (i.e. with a C- or better).

Yes

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* 10. I understand that I must complete Part 2 of this Application. Part 2 is the Application Packet consisting of the Criteria Form, Release Form, and a copy of my unofficial transcripts.

I understand that the completed Application Packet must be received by 5:00 p.m. on September 9, 2020, in order for my application to be considered for the apprenticeship.

Yes