- MsRWA | Mississippi Rural Water Association

MsRWA Apprenticeship Application

This application contains all the necessary information for MsRWA to compile the sign up documents for participation in the program.

Apprentice Name, Address, Phone, Email

Potential Apprentice Name(Required)

First Middle Last

Potential Apprentice Address(Required)

Street Address Address Line 2 City State ZIP Code

Potential Apprentice Phone(Required)

Potential Apprentice Email(Required)

Apprentice Date of Birth, Drivers License, Diploma

Please Provide Scanned Copies of Drivers License and Diploma or G.E.D

Potential Apprentice Date of Birth(Required)

MM slash DD slash YYYY

MsRWA Apprenticeship requires the applicant to be at least 18 years of age.

Does the potential apprentice possess a valid state issued vehicle operator license and can be insurable at normal commercial rates.(Required)

Yes

Please Submit a Copy of Valid Drivers License for Proof of Age and License(Required)

Max. file size: 2 MB.

Potential Apprentice Education Level(Required)

Highschool Diploma

G.E.D

MsRWA Apprenticeship requires either a HS Diploma or a G.E.D to participate.

Date of Graduation(Required)

MM slash DD slash YYYY

Name of School or G.E.D(Required)

Please Submit a Copy of Diploma or G.E.D Certificate(Required)

Max. file size: 2 MB.

Apprentice Physical Ability, Drug Screen & Background Check or Hiring Letter

Is the applicant physically able of performing the essential functions of the program, with or without reasonable accommodation, and without---posing a direct threat to the health and safety of the individual or others.(Required)

Yes

The applicant must be capable of essential functions to participate in the program.

Drug Screen / Background Check OR Employment Letter(Required)

The applicant has had a Drug Screen and Background Check

The applicant has NOT had a Drug Screen and Background Check

If no Drug Screen or Background Check has occured please provide a signed letter stating that the apprentice has met the hiring requirements of the system on company letterhead.

Drug Screen / Background Check OR Employment Letter(Required)

Max. file size: 2 MB.

Please Provide either Drug Screen / Background Check documents or Hiring Letter.

Apprentice Information

If you do not wish to answer the following questions please select " Do not wish to answer"

Sex(Required)

Male

Female

Do not wish to answer

Ethnic Group(Required)

Veteran Status(Required)

Non-Veteran

Veteran

Do not wish to answer

Military Service

Education Level(Required)

Potential Apprentice Employer Information

Please Provide the Following Information as the Employer

Employer / Organization Name(Required)

Organizations EIN#(Required)

*The term employer identification number (EIN) refers to a unique identifier that is assigned to a business entity so that it can easily be identified by the Internal Revenue Service (IRS). EINs are commonly used by employers for the purpose of reporting taxes. The number is made up of nine digits and is formatted as XX-XXXXXXX. Businesses can apply for EINs directly through the IRS, which usually issues them immediately. The EIN is required by the Department of Labor for Participation in the Program.

Employer Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please only use a P.O Box if no physical address exists.

Employer / Organization Contact *Mayor or President(Required)

First Last

Employer / Organization Contact *Mayor or President Phone(Required)

Employer / Organization Contact *Mayor or President Email(Required)

Mentor / Supervisor Name(Required)

First Last

Mentor / Supervisor Phone(Required)

Mentor / Supervisor Email(Required)

General Information about Organization

How many total employees does the organization employ?(Required)

How many Certified Operators are currently employed?(Required)

How many of these Certified Operators are Female?(Required)

How many of these Certified Operators are Minorities?(Required)

How many water connections does the organization serve?(Required)

Enter N/A if no water connections

How many wastewater connections does the organization serve?(Required)

Enter N/A if no wastewater connections

What Class Water System is the Organization?(Required)

Not a Water System

What Class Wastewater System is the Organization?(Required)

Not a wastewater system

Apprentice Pay Amounts

The MsRWA Apprenticeship Program requires that the employers agree to quarterly pay increases to participate in the program. This means that upon completion of each of the four quarters of the two-year program there will need to be a pay increase. The apprentice will need to meet all requirements before the increase is implemented.

Starting Hourly Pay / Current Hourly Pay:(Required)