Pre-Apprentice Application for the Dairy Laborer Pre-Apprenticeship

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First Name*

Last Name*

Email*

Cell Phone Number*

Address*

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

County*

Parent/Guardian Name(s)*

Parent/Guardian Phone Number(s)*

Birthdate*

Gender*

Female
Male
Do not wish to answer

Ethnicity*

Hispanic/Latino
Not Hispanic/Latino
Do not wish to disclose

Race*

American Indian or Alaskan Native
Asian
Black or African American
Hawaiian Native or Pacific Islander
White
Do not wish to disclose

Veteran Status*

Veteran
Non-Veteran
Do not wish to disclose

Disability*

Yes
No
Do not wish to disclose

Criminal Background (Misdemeanor or Felony)*

Yes
No
Do not wish to disclose

Pre-Apprentice Education and Farm Experience

Name of High School Attending/Attended*

High School Town Name*

What grade are you currently in?*

Grade 10
Grade 11
Grade 12

Are you enrolled in an Agriculture Education program at school?*

Yes
No

Name of Ag Educator*

How many years of farm experience do you have?*

List any previous work experience.*

Why are you interested in participating in the Dairy Laborer Pre-Apprenticeship?*

Provide a person who would be willing to be contacted as a reference.*

Please include first and last name, their farm/or business they are associated with, and their email and cell number.

Signature & Confirmation

Please check below if you have reviewed the Pre-Apprentice Expectations and agree to adhere to these guidelines.*

Yes, I have reviewed the Pre-Apprentice Expectations and agree to adhere to these guidelines.

Please check below if you confirm this application is completed honestly and accurately. By checking, you are electronically signing your application.*

I confirm that I completed this application honestly and accurately. I acknowledge this is my electronic signature.

If selected, the pre-apprentice agrees to fulfill all the program requirements of the Dairy Laborer Pre-Apprenticeship. If the program requirements are not met, The Center for Dairy Excellence reserves the right to dissolve the experience with advance notice to pre-apprentice.

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