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Personal Information
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Drivers License Info
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Employment Questionnaire
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Education
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Employment History
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Privacy Act Statement
The Information request herein is a voluntary disclosure and is used for Apprentice Program
Statistical Purposes and will only be disclosed in accordance with the provisions of the Privacy
Act (Privacy Act 0f 1974- P.L - 93-579)
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Notice To Applicants
This organization does not require a pre-acceptance medical examination, but the contractor members of this
organization do reserve the right to require drug testing and/or a medical examination after an offer of
employment is made to an applicant. Offers of employment are conditioned upon the passing of a drug test for
the purpose of detecting the illegal use of drugs. Also, if an employment offer is made, you may be asked to
answer certain medical questions. An applicant will not be excluded from employment unless they have medical
conditions that prohibit their ability to perform the essential job functions of electrical apprentice, with
or without reasonable accommodations.
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Representations & Waivers
Read the following conditions. If you have any questions regarding the conditions, you should ask for a
full explanation or clarification from the IEC office (219-900-0091). Signify your understanding and specific
acceptance of each condition by your signature in the space provided at the end of this form.
I hereby authorize the Independent Electrical Contractors Association to investigate any and all statements
contained in this application. I hereby consent to the IEC Association conducting any checks concerning by
background which are deemed necessary, advisable or helpful by the IEC Association (except contracting my
current employer, unless permission is granted above). I understand that failure to produce a valid driver’s
license and a clean driving record will not prohibit my acceptance into the program but may limit the ability
of the IEC to place me with a member. I may be required to submit to a drug test. I hereby consent to a drug
test and waive any and all objections I might otherwise have to such a drug test. I understand that all statements
made this application are true and complete to the best of my knowledge and without mental reservations. I
understand that falsification of this application may result in my not being considered for acceptance or, in the
event that I am accepted by the Independent Electrical Contractors Association, in my dismissal from the program.
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