DES MOINES APPRENTICESHIP RE-INTERVIEW APPLICATION REQUEST FORM

First Name       Last Name                     Date      
                                  

Address               Apt.                                                                        
                                                  

 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:

 (Inside Program) Gained at least 450 hours of electrical construction related on-the-job experience since my last interview

(Residential or Telecom) Gained at least 1000 hours of electrical construction related on-the-job experience since my last interview

or

Sucessfully completed two or more post-secondary trade related classes, since my last interview.

APPLICATION FEE

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.

DES MOINES ELECTRICAL APPRENTICESHIP

10700 Justin Dr.

Urbandale, Iowa 50322

**Do Not Send Cash – Only Checks or Money Orders Are Acceptable Payment**

Signature          

                                                                                
  Date

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.

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