APPRENTICE AGREEMENT - California

A.
Gender
C. Number of Dependents (Do not count yourself)
Male
Female
0
None 4 Four
(Cal. Code of Regulations, Title 8, Ch. 2, Sec. 215 1 One 5 Five
B.
Ethnic or Race Derivation (Check only one
)
2 Two 6 Six of More
1
3 Three
(Voluntary)
2
D. Highest Year of Education Completed
1
8th Grade or less 6
1 Year of College
2
9th Grade 7
2 Years of College
3
10th Grade 8
3 Years of College
4
11th Grade 9
A
Asian Asian Indian
5
B Asian Bangladeshi
C
Asian Chinese (Cal. Labor Code, Ch. 4, div. 3, Sec. 3076.3)
D
Asian Cambodian
E.
6
Asian Filipino
0
None
E
Asian Hmong
1
Less Than 1 Year
I
Asian Indonesian
2
1 But Less Than 2 Years
J
Asian Japanese
3
2 But Less Than 3 Years
K
Asian Korean
4
3 But Less Than 4 Years
L
Asian Laotian
5
4 But Less Than 5 Years
M
Asian Malaysian
6
5 Years or More
P
Asian Pakistani
R
Asian Sri Lankan
(Voluntary)
T
Asian Taiwanese
F.
U
Asian Thai
Yes
No
V
Asian Vietnamese If yes, Please Enter:
F
Native Hawaiian Fijian Month and Year Entered ______________________
G
Native Hawaiian Guamanian Month and Year Separated ____________________
H
Native Hawaiian Hawaiian Total Months served on Active Duty _____________
S
Native Hawaiian Samoan
W
Native Hawaiian Tongan
4
7
(Cal. Labor Code, Ch. 4, div. 3, Sec. 151)
TO THE APPRENTICE: California Civil Code Sec. 1798.17 requires State agencies which collect personal information to indicate the
authority under which the data are requested. If personal information not specifically authorized by law is requested, individuals must be
informed that supplying the information is voluntary. It also provides that state agencies may change or modify records at the request of the
individual.
Questions C and E below are voluntary. All others are authorized by law, as indicated by the reference in each section. If the authorized
questions are not answered, the apprentice agreement cannot be accepted.
The Division hopes, through collection of this data, to improve the apprenticeship program both for those presently enrolled and for future
apprentices. Thank you.
CALIFORNIA APPRENTICE QUESTIONNAIRE
(USE INK OR BALLPOINT PEN)
WHITE (Not of Hispanic Origin) -- A person having origins in
any of the original peoples of Europe, North Africa or the Middle
East.
BLACK (Not of Hispanic Origin) -- A person having origins in
any of the Black racial groups of Africa.
Number of Years You Have Been Employed Full Time to Date
(Except for Military Service)
ASIAN OR PACIFIC ISLANDER -- A person having origins in
any of the original peoples of the Far East, Southeast Asia, the
Indian Subcontinent or the Pacific Islands. The area includes,
for example, China, Japan, Korea and Samoa.
AMERICAN INDIAN OR ALASKAN NATIVE -- A person having
origins in any of the original peoples of North America, and who
maintains cultural identification through tribal affiliation or
community recognition.
Have You Served on Active Duty (other than reserve status) in
the U. S. Armed Forces?
HISPANIC -- A person of Mexican, Puerto Rican, Cuban, South
Central American or other Spanish culture or origin, regardless
of race.
4 or more Years of
College
12th Grade (or GED
Certificate)
Apprentice's Signature _____________________________________
Page 2/2
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