Applicant Registration Applicant Registration Step 1 of 4 25% Please fill out the form on the following pages. Once completed, you will receive an email with payment information. Here are Important Facts Before You Apply links. Click the link of the area you are looking to make application in:Baltimore, MarylandSeaford, DelawareHagerstown, MarylandTo proceed past this first step, you must acknowledge that you have read the “Important Facts Before You Apply" information.* I have read and understand the Important Facts Before You Apply information necessary for an applicant to be considered for a probationary pipe trades apprenticeship. What school location are you applying for:* Hagerstown, MD (School year 2022-2023) Seaford, DE (School year 2022 – 2023) Baltimore, MD (School year 2022 – 2023) Name of Applicant* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Main Phone*Mobile PhoneEmail* Enter Email Confirm Email Gender* Male Female Ethnicity* African American American Indian or Alaskan Native Asian or Pacific Islander Caucasian Hispanic Other Other Ethnicity (please specify)* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Education* High School Graduate Graduate High School This Year GED Some College AA Degree Bachelor’s Degree or more High School Name & State* Additional Education BackgroundVeteran* Yes No Which Branch of Service?* Length of Service* Date of Discharge* MM slash DD slash YYYY Type of Discharge* Currently Employed* Yes No Work ExperienceEmployer (1) City (1) Type of Work (1) Date From (1) MM slash DD slash YYYY Date To (1) MM slash DD slash YYYY Reason for Leaving (1) Employer (2) City (2) Type of Work (2) Date From (2) MM slash DD slash YYYY Date To (2) MM slash DD slash YYYY Reason for Leaving (2) Employer (3) City (3) Type of Work (3) Date From (3) MM slash DD slash YYYY Date To (3) MM slash DD slash YYYY Reason for Leaving (3) Employer (4) City (4) Type of Work (4) Date From (4) MM slash DD slash YYYY Date To (4) MM slash DD slash YYYY Reason for Leaving (4) Employer (5) City (5) Type of Work (5) Date From (5) MM slash DD slash YYYY Date To (5) MM slash DD slash YYYY Reason for Leaving (5) How have you learned of the Plumbers & Steamfitters Local Union 486 Apprenticeship Program? (check all that apply)* Facebook Internet Search Job Site Local 486 Member Print Advertising Radio Relative School Counselor/Teacher Other Organization/Agency TV Twitter Website Other What Search Engine? What Job Site? Name of Local 486 Member What Publication? What Station? Name of Relative Name of School Counselor/Teacher Name of Agency/Organization Name of Online Website Other, please explain Have you previously made application to our school? Yes No Have you previously been accepted to our school? Yes No Do you have cable television? Yes No What TV programs, shows or sporting events do you like to watch? Do you use the Internet? Yes No What Search Engine Page do you use the most? (i.e., Google, AOL, Yahoo) Have you ever looked for local employment on the Internet? Yes No On which sites did you look for employment? Choose your age group*18-2223-2526-3031+ Billing DetailsBilling Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Product NameTotal $0.00 CAPTCHAConsent I agree to the privacy policy.
