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PRE-Apprenticeship for
Highway Construction Careers |
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| Application |
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Please answer all questions. |
| PERSONAL INFORMATION |
Mr.
Ms. First Name:
Last Name:
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| Address:
Apt #
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| City:
Zip:
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| Phone:
Email:
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| EDUCATION (select highest completed) |
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Do you have a High School
Diploma or
GED
Yes
No |
| GENERAL INFORMATION
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Why are you applying for this program?
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| How did you hear about this program?
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Can you commit to attending this class for 6 weeks? (Monday through Friday, 8 a.m, to
3 p.m.)
Yes
No |
| If you are NOT selected for this session, do you wish to be considered for a later session? |
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Yes
No |
Please provide any other information that you feel would be helpful.
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| EEO SELF IDENTIFICATION |
The Arizona Department of Transportation is an equal opportunity affirmative action employer. As such, ADOT is subject to US governmental recordkeeping and reporting requirements in accordance federal civil rights laws and regulations. In order to comply with these laws, ADOT is required to collect data for statistical purposes about its workforce [anyone working for or at ADOT work sites]. Information will be kept confidential and will be used only for statistical purposes. Your cooperation is vital and greatly appreciated. |
| VETERANS STATUS |
| Are you a Veteran?
Yes
No |
| ETHNICITY (Choose only ONE of the following, you can click on the ethnicity to see a description) |
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Hispanic/Latino
Not Hispanic/Latino |
| RACE (Choose only ONE of the following, you can click on the races to see a description) |
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White |
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Black |
American Indian or Alaskan Native |
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Asian |
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Native Hawaiian or Other Pacific Islander |
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Two or more races |
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I do not wish to self-identify. Choosing not to self-identify will NOT jeopardize or affect your status in any way. |
| QUESTIONS? Call Mary M. Cook, Program Manager, 602.712.7761 |
| By selecting "Submit Form" you are verifying that the statements made on this application are true and correct. The confirmation page you should see, after successfully submitting this form includes useful information about the training. Please take a few minutes to review. |
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