DES MOINES APPRENTICESHIP RE-INTERVIEW APPLICATION REQUEST FORM
First Name Last Name Date
City State Zip
Phone Number Email address
I do hereby request an application form to apply for the apprenticeship program.
I understand and accept full responsibility for completing the application form upon receipt, returning it to the
apprenticeship office, and submitting all subsequent required documents and information within the
specified time frame.
I am requesting this application form for my own personal use.
I understand that it is my responsibility to keep the apprenticeship program’s office notified of my current
mailing address and telephone number.
I understand that in order to be considered for a re-interview I must submit documentation which certifies that I have either:
Gained at least 1000 hours of electrical construction related on-the-job experience, since my last interview
Sucessfully completed two or more post-secondary trade related classes, since my last interview.
In order to receive the Application Form for re-interview, an Application Fee of $5.00 for Each
Application, must Accompany this “Apprenticeship Application Request Form”. Make Your Check of
Money Order Payable To:
DES MOINES ELECTRICAL APPRENTICESHIP
Please Note, If Your Check Is Returned by Your Banking Institution, Your Application Will Be
Withheld from Further Processing until Full Payment Is Properly Made – Including Reimbursement for
Any Returned Check Charges.
If You Are Mailing This Form, Be Sure to Enclose Your Payment If You Wish to Receive an
Apprenticeship Application Form.
10700 Justin Dr.
Urbandale, Iowa 50322
**Do Not Send Cash – Only Checks or Money Orders Are Acceptable Payment**
The recruitment, selection, employment and training of apprentices during their apprenticeship,
shall be without discrimination because of race, color, religion, national origin, sex or age –
except the applicant must be at least 17 years of age to apply and 18 years of age at time of
indenture. The JATC does not, and will not, discriminate against a qualified individual with a
disability because of the disability of such individual.