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APPRENTICESHIP APPLICATION AND CONTRACT ________________________________________________________________________________________________________ Please read the Information and Instructions carefully. Submit all completed forms, documents and fee(s) to your local ECE Service Centre. If you need help in completing this form, a Career Development Officer (CDO) can provide assistance and information. See page 6 of this application for addresses and telephone numbers. Please note: There is a non-refundable $50.00 application fee for the Apprenticeship Application and Contract that must be submitted with the completed application. If you have previous technical training, vocational training or pre-employment certification (trades education) that you would like to have credited to your apprenticeship contract then you must complete a Prior Learning Assessment Review (PLAR) Application before submitting this application. There is an additional $100.00 fee for a Progressive Examination. Refer to page 4 and section 5 Previous Work Experience in the Trade. These examinations are to be done first and the results will be added to previous work experience credits and applied to your Apprenticeship Application and Contract. The personal information collected in this application will be used to determine your eligibility to participate in the NWT Apprenticeship Program. This information and the personal information we obtain throughout your program will be used to: Administer your apprenticeship program, Register you in technical training, Govern the Apprenticeship, Trade and Occupation Certification Act and the Apprenticeship and Trade Certification Regulations, Help you gain financial support under the Employment Insurance Act (Canada) or other financial assistance programs to which you apply, and It may also be used to facilitate your involvement in the Interprovincial Red Seal Program, for research and statistical purposes, and may be provided to Statistics Canada where required.

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APPRENTICESHIP APPLICATION AND CONTRACT

________________________________________________________________________________________________________ Please read the Information and Instructions carefully. Submit all completed forms, documents and fee(s) to your local ECE Service Centre. If you need help in completing this form, a Career Development Officer (CDO) can provide assistance and information. See page 6 of this application for addresses and telephone numbers.

Please note:

There is a non-refundable $50.00 application fee for the Apprenticeship Application and Contract that must be submitted with the completed application.

If you have previous technical training, vocational training or pre-employment certification (trades education) that you would like to have credited to your apprenticeship contract then you must complete a Prior Learning Assessment Review (PLAR) Application before submitting this application.

There is an additional $100.00 fee for a Progressive Examination. Refer to page 4 and section 5 Previous Work Experience in the Trade. These examinations are to be done first and the results will be added to previous work experience credits and applied to your Apprenticeship Application and Contract.

The personal information collected in this application will be used to determine your eligibility to participate in the NWT Apprenticeship Program. This information and the personal information we obtain throughout your program will be used to:

Administer your apprenticeship program,

Register you in technical training,

Govern the Apprenticeship, Trade and Occupation Certification Act and the Apprenticeship and Trade Certification Regulations,

Help you gain financial support under the Employment Insurance Act (Canada) or other financial assistance programs to which you apply, and

It may also be used to facilitate your involvement in the Interprovincial Red Seal Program, for research and statistical purposes, and may be provided to Statistics Canada where required.

Page 2 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

Apprenticeship Programs available in the NWT

All applications, when completed and signed by the applicant and the employer, are to be delivered or sent to your local ECE Service Centre listed on the page 6. Incomplete applications and applications missing the required transcripts or documents will be returned to the client for corrections.

Page 3 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

Instructions for Apprenticeship Application and Contract

Following these steps will allow your application to be processed quickly: 1. Read all the questions carefully and answer them completely. The numbered explanations in

these pages correspond to the numbered sections on the application. 2. Print in ink. 3. Attach the required documentation. 4. Submit your signed and completed application, transcripts, other documents and fee(s) to your

nearest ECE Service Centre (as listed on page 6).

1. Trade Print the name of the trade in which you want to apprentice. See Page 2 for the list of NWT designated

trades. Also, please specify if you are entering an apprenticeship as a student under the Students North Apprenticeship Program (SNAP).

2. Personal Information Section 2 is to be completed by the person applying to become an apprentice.

Please ensure that you have completed the application and that you have signed section 3 (page 9) and section 8 (page 13) of the application.

Response to the question on Aboriginal status is voluntary. The information is being collected to ensure the Department of Education, Culture and Employment meets its mandate and responsibilities to measure system effectiveness and develop policies, programs and services to improve Aboriginal learner success.

If you change your name or address in the future, contact your ECE Service Centre immediately so your records can be updated.

If you have a learning disability, special accommodations may be available for technical training; however, you must provide the appropriate documentation for your special needs four weeks prior to attending training. Special needs include learning disabilities, hearing/visual impairments, and language barriers.

3. Privacy Notice and Consent to Disclose Personal Information In this section we ask you to provide your consent to the Department of Education, Culture and Employment

to disclose the personal information you provide on the application for specified purposes and to specified third parties.

Your consent is voluntary. If you do not give your consent, it will not stop your application from being considered or stop your participation in an apprenticeship program. However, without consent, you will be unable to register in technical training. In addition, it may restrict your ability to receive an award recognizing your achievement as an apprentice.

You may withdraw your consent at any time, but must do so in writing to the Apprenticeship, Trade and Occupation Certification Headquarters office (as listed on page 6).

Sign and date your consent to disclose personal information.

4. Previous Education and Trades Education Describe the formal or trades education you have completed in the trade identified in section 1. If you need

more space, put the additional information on a separate page.

List any certificate, credentials, or transcripts you hold for the trade identified in section 1 or in any other trade. If you need more space, put the additional information on a separate page. Attach a certified true

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

copy of each certificate, credential or transcripts to your application. A certified true copy is a copy that is certified to be an exact copy of the original. A lawyer or notary public can verify for you.

If you have previous technical training, vocational training or pre-employment certification (trades education) that you would like to have credited to your apprenticeship contract then you must complete a Previous Learning Assessment Review (PLAR) Application before submitting this application.

If you request a PLAR, there is a non-refundable $100.00 fee and a separate PLAR Application. After a PLAR is received, the ATOC Certification Officer may grant credit for trades education that will be added in section 9. For any previous traded education that is rejected, the ATOC Certification Officer will note the rejection in the Notes/Explanations in the PLAR Application. This assessment applies only to previous trades education, not work experience credits.

PLARs do not apply to apprentices registered in other jurisdictions. If you wish to transfer an apprenticeship contract from another jurisdiction use this application only.

If you have no training or experience in the trade identified in section 1 please attach the results of the appropriate Trades Entrance Exam.

5. Previous Work Experience in the Trade Starting with your previous employer, describe the work experience you have in the trade shown in section 1.

If you need more space, put the additional information on a separate page (Note: This information is subject to verification).

This information, together with the recommendation of your employer, may be used to grant you credit toward work experience component of the apprenticeship program. Should you qualify for work experience credit, you may be eligible to write one or more progressive examinations to determine your level of competency. You will be advised if you are eligible to write a progressive examination. There is a non-refundable $100.00 fee for writing each progressive examination.

The progressive examination combined with previous work experience is used to determine the entry level of prospective apprentices. Candidates who have skills and knowledge but no formal trades technical training may enter the program at an advanced level. Employer recommendation is required. Advanced placement is only available in level one (1) or two (2) of the apprenticeship program. No technical training is required when you pass the apprentice level theory examination and you have the required work experience – 1800 hours for level one (1) and 3600 hours for level two (2). The candidate must write at least a level one (1) for 1800 hours and write a level two (2) theory examination when there is 3600 hours of work experience.

Remember, there is a 10 year limit on previous work experience credit. Only work experience gained with in the last 10 years will be recognized.

Candidates who fail the progressive exam must enter at that level and attend the corresponding level of technical training. Supplemental examinations are not allowed. Credit passes are allowed.

6. Current Employer Information Section 6 must be completed by the employer. The employer’s signature is also required in section 8 (page 13).

All fields in this section are mandatory.

If you change the name, address, or email address of your business, please contact your ECE Service Centre immediately so your records can be updated.

Please include the name and certification number(s) of the Journeyperson(s) who will be mentoring the apprentice. If your supervising Journeyperson was certified outside of the Northwest Territories you must include a copy of their Journeyperson Certificate.

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

7. Recommended Credit Section 7 must be completed by the employer.

If the applicant has previous work experience in the trade, as indicated in sections 5 and 6 of the application, you (the employer) may recommend that the applicant be granted time credit toward the on-the-job training component of the apprenticeship program. You (the employer) must indicate the TOTAL recommended time credit the applicant is to receive in hours (e.g. 2100 hours). If this section is left blank then no credit will be awarded.

If the time credit recommended for on-the-job training exceeds one year, you (the employer) may also recommend the applicant challenge the progressive examination(s) instead of taking technical training (Note: There is a fee for the progressive examination(s)). As the employer, you must check one box only in support of a recommendation that the applicant challenge the progressive examination(s) or attend technical training.

8. Contract of Apprenticeship and Signatures Please read this section carefully and sign if you agree. Both the applicant’s employer and the applicant must sign the application in order for it to be processed.

9. Work and Trades Education Credit(s) This section outlines the results of the work credit hours declared in the application and the results of the PLAR assessment (if applicable). The ATOC Certification Officer completes this section and reserves the right to review, verify, approve or reject an apprenticeship application, work credits and previous trades education. If there is a rejection of work credit hours it will be noted in this section. Rejection of previous trades education credit will be noted in the PLAR application. The applicant may review the results with a CDO upon contract approval or rejection.

All applications, when completed and signed by the applicant and the employer, are to be delivered or sent to your local ECE Service Centre listed on the next page. Incomplete applications and applications missing the required transcripts or documents will be returned to the client for corrections.

APPRENTICESHIP APPLICATION AND CONTRACT PACKAGE CHECKLIST

√ Signed and completed Apprenticeship Application and Contract – make sure the employer

and/or supervising journeyperson signs as well $50.00 Apprenticeship Application and Contract fee made payable to the Government of the

Northwest Territories - please pay by cheque or money order Official or certified true copies of certificates, credentials and or transcripts from previous

technical training institutions (if applicable)

Results letter from Trades Entrance Exam– ask your CDO for a copy (if applicable) Signed PLAR Application results letter (if applicable) Completed Apprenticeship and TQ Fees Form

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

ECE Service Centres City/Town Address Phone Number

Fort Simpson ECE Service Centre, Deh Cho Region Education, Culture and Employment Government of the NWT Deh Cho Regional Education Centre, 9802-98

th Ave.

Box 740 Fort Simpson, NT X0E 0N0

Phone: (867) 695-7338 Fax: (867) 695-7351

Yellowknife ECE Service Centre, North Slave Region Education, Culture and Employment Government of the NWT Nova Plaza, 5019-52

nd Street

Box 1320 Yellowknife, NT X1A 2L9

Phone: (867) 766-5100 Fax: (867) 873-0423

Norman Wells ECE Service Centre, Sahtu Region Education, Culture and Employment Government of the NWT BOX 147 Norman Wells, NT X0E 0V0

Phone: (867) 587-7161 Fax: (867) 587-2612

Inuvik ECE Service Centre, Inuvik Region Education, Culture and Employment Government of the NWT Suite 293, 2

nd Floor

106 Veteran’s Way Inuvik, NT X0E 0T0

Phone: (867) 777-7365 Fax: (867) 777-7218

Hay River ECE Service Centre, Hay River Education, Culture and Employment Government of the NWT Courthouse Building, 8 Capital Drive HAY RIVER, NT X0E 1G2

Phone: (867) 874-5050 Fax: (867) 874-5062

Fort Smith

ECE Service Centre, South Slave Region Education, Culture and Employment Government of the NWT Sweetgrass Building, 177 McDougal Road Box 1406 Fort Smith, NT X0E 0P0

Phone: (867) 872-7425 Fax: (867) 872-4507

Yellowknife (Headquarters)

Apprenticeship and Occupational Certification Advanced Education Education, Culture and Employment Government of the NWT Box 1320 Lahm Ridge Tower – 1

st Floor, 4501-50

th Street,

YELLOWKNIFE NT X1A 2L9

Phone: (867) 873-7552 Fax: (867) 873-0200

Page 7 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

1. Trade and Apprenticeship Program

In What NWT trade are you applying to be an apprentice?

SNAP? Are you applying as an apprentice under the Schools North Apprenticeship Program?

2. Personal Information

Date: yyyy/mm/dd

Social Insurance Number:

Legal Last Name: Former Last Name: (if applicable)

Legal First Name: Middle Name: (full name, no initials)

Preferred First Name:

Mailing Address: P.O. Box: Street:

City: Province/Territory: Postal Code:

Cell Phone No: Home Phone No: Work Phone No:

E-mail Address:

Gender: Male Female Birth date: yyyy/mm/dd

If you require special needs services, describe the services you require: (Include official documentation)

Have you completed a Trade Access Program? Yes No

Have you been involved in Skills Canada NWT programs? Yes No

May we share your contact information with Skills Canada NWT? Yes No

Did you participate in the South Slave Trades Awareness Program? Yes No

If you wish to declare your aboriginal status, please specify: Dene

Metis

Inuit

Southern Aboriginal

Non-Aboriginal

Other (please specify) ________________________________

Submitting CDO: _______________________________

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

3. Privacy Notice

(Please Read Carefully Before Signing the Disclosure of Personal Information Form) Education Culture and Employment collects personal information from you for the purposes of administering and enforcing the Apprenticeship Trade and Occupations Certification Act and for administering apprenticeship and certification programs.

“Personal Information” for the purposes of the Disclosure of Personal Information form includes such things as your name, address, telephone number, date of birth, gender, social insurance number, identification number, examination marks, trade certificates(s) held, course work, training and work experience completed.

The Access to Information and Protection of Privacy Act allows Education Culture and Employment to collect, use and disclose your personal information for the purpose(s) for which it was collected, for a consistent purpose and, with your written consent, for the purposes and to the persons or bodies listed on the Disclosure of Personal Information form.

Education Culture and Employment will disclose only the personal information that is needed for an authorized purpose and will protect your personal information from unauthorized access, use, disclosure or disposal.

You do not have to sign this Disclosure of Personal Information form. However, if you do not sign the form, there may be delays in processing your application, in issuing your trade certificate or Interprovincial Red Seal, in finalizing your examination/school marks, in releasing your examination/school marks or in you being able to work in your trade in another province or territory.

If you do not wish to have your personal information disclosed to certain persons, bodies or for specified purposes, you may cross them out on the Disclosure of Personal Information form. This may result in some of the delays listed above.

You may withdraw your consent at any time, but you must do so in writing and you must send the notice of withdrawal to:

Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment Government of the Northwest Territories Box 1320 Yellowknife NT X1A 2L9

The personal information collected by Education Culture and Employment will be used and disclosed only for the purposes for which it was collected, for a consistent purpose or for the purposes listed on the attached Disclosure of Personal Information form. You have a right to request access to your own personal information to ensure that it is accurate and completed and to request that a correction be made if it is not accurate.

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

3. Disclosure of Personal Information

I give the GNWT, Department of Education, Culture and Employment, consent to disclose any necessary personal information as it relates to my participation in an apprenticeship or occupational certification program and subsequent certification: 1. To the providers of the formal instruction component of apprenticeship programs, to my employer, to

industry representatives and to officials of Advanced Education, Apprenticeship, Trade and Occupation Certification, other government departments, other provinces and territories, and the federal government for purposes of making decisions related to:

my registration in a technical training program;

my progress as an apprentice in my apprenticeship program;

the issuance of an NWT trade certificate to me;

my eligibility to apply to write the Interprovincial Standards (Red Seal) Program examination (if and when available in my trade): and,

my eligibility to participate in other apprenticeship certification programs in Canada. 2. To officials of Education, Culture and Employment, other NWT Government departments, other

provinces and territories and the federal government for the purposes of;

administering the Interprovincial Standards (Red Seal) Program;

evaluating the NWT apprenticeship program, other provincial and territorial apprenticeship programs certification programs; and/or,

collecting labour market information for research and statistical purposes. 3. To any Member of the Northwest Territories Legislative Assembly, any group, organization or

association for the purposes of being considered for an award or scholarship or congratulated for an award or scholarship. The information regarding award recipients (i.e. name, award received and photo) may be published in local or national media.

The signing of this form is strictly voluntary. I understand that I may withdraw my consent at any time, but that I must do so in writing. Signature of Applicant: Date: yyyy/mm/dd _

Page 10 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

4. Previous Education and Trades Education

What is the highest level of education you completed?

Name of high school: (attending or most recently attended)

Community of high school: Province/Territory: Last year attended: Last grade completed:

Name of Post-Secondary Institution (university/college): (most recently attended)

Community of institution: Province/Territory: Last year attended:

Credential obtained:

Describe the previous trades education (vocational, pre-employment, technical training) you have completed in the trade identified in Section 1 or in any other trade. If you need more space, put the additional information on a separate page. Attach the original or a copy of all supporting documentation (e.g. certificate, diploma or transcript) to your application. If you have previous technical training that you would like applied to your apprenticeship application and Contract then enter your previous trades education obtained on the PLAR application.

Course or program: (most recently attended)

Name of institution:

Location: Date started: yyyy/mm/dd Date completed: yyyy/mm/dd

Certificate and level obtained:

Course or program: (other than most recently attended)

Name of institution:

Location: Date started: yyyy/mm/dd Date completed: yyyy/mm/dd

Certificate and level obtained:

Are you currently or have you ever been registered in an apprenticeship program before? Y/N In which trade?

If so, what is the jurisdiction of your apprenticeship? (Where was your apprenticeship? Province/Territory)

**If you were registered apprentice in another jurisdiction you must include a copy of your apprenticeship record to receive credit**

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

5. Previous Work Experience in the Trade

Name of Business:

Site Address:

P.O. Box: Street:

City: Province/Territory: Postal Code:

Phone No: Alternative Phone No: Fax No:

Name of contact person: (Name, Position and Phone Number, with Area Code)

Tasks Performed: (What is your hands-on-experience in the trade?)

Date Started: yyyy/mm/dd Date Finished: yyyy/mm/dd Total Hours:

Supervising Journeyperson: Name

Certificate of Qualification Number Certifying Jurisdiction

Interprovincial Red Seal Number Date of Certification

Name of Business:

Site Address:

P.O. Box: Street:

City: Province/Territory: Postal Code:

Phone No: Alternative Phone No: Fax No:

Name of contact person: (Name, Position and Phone Number, with Area Code)

Tasks Performed: (What is your hands-on-experience in the trade?)

Date Started: yyyy/mm/dd Date Finished: yyyy/mm/dd Total Hours:

Supervising Journeyperson: Name

Certificate of Qualification Number Certifying Jurisdiction

Interprovincial Red Seal Number Date of Certification

Page 12 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

6. Current Employer Information

Legal Name of Business:

Operating Name of Business:

Mailing Address: P.O. Box: Street:

City: Province/Territory: Postal Code:

Phone No: Alternative Phone No: Fax No:

Site Address: (If different from mailing)

Street:

City: Province/Territory: Postal Code:

Employer Contact Person:

Email Address:

When did the applicant begin to work in this trade for your business prior to the contract start date? yyyy/mm/dd How many hours has the applicant worked in this trade for your business up to the date this contract is signed?

To be completed by the applicant’s supervising journeyperson: Name: (Please Print) _Date of Birth____ yyyy/mm/dd ____________Gender m/f______ Certificate of Qualification Number: _________________ Issuing Province/Territory: ______________ Date of Certification: _ yyyy/mm/dd Red Seal Number: _ Issuing Province/Territory**: __________________________ Date of Certification: _ yyyy/mm/dd **Note that if the applicant’s supervising journeyperson was certified outside of the Northwest Territories a copy of their Journeyperson Certification must be attached to this application. Address:___________________________________Community:___________________________________Postal Code:__________________ Email address: (mandatory)_____________________________________________________________________________________________ Phone Number: (mandatory)____________________________________________________________________________________________ Signature: _ Signature Date: __ yyyy/mm/dd _____________

If you wish to participate as a Subject Matter Expert (SME), to assist in the delivery of the NWT Apprenticeship Program, please fill out the following information, and identify what activities you may be interested in. Check all that apply:

Trade Advisory Committee (TAC) National Occupational Analysis (NOA) workshop Item Bank development workshop Interprovincial Program Guide (IPG) Evaluator

Page 13 of 14

APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

7. Employer Recommended Credit

Trade related work experience from previous employers (not registered with another jurisdiction) A

Work experience with current employer before the contract start date B

Credit from PLAR application C

Maximum credit available (subject to approval from employer of contract) A+B+C

How much TOTAL trade experience credit should the applicant be granted?

Work experience as a registered apprentice in another province/territory

Total number of work experience hours to be applied to this contract

Level 1 Progressive Exam Level 2 Progressive Exam OR Must Attend Technical Training

8. Contract of Apprenticeship and Signatures EMPLOYER

When the employer and the apprentice sign this document, the document becomes a Contract of Apprenticeship. The Employer and Apprentice agree that:

The applicant shall be an apprentice under the Apprenticeship, Trade and Occupational Certification Act in the trade identified in Section 1 of the application.

The Apprentice shall complete the apprenticeship program as required under the applicable regulations, or as agreed by the Director and the Employer in accordance with the Apprenticeship, Trade and Occupational Certification Act.

The on-the-job training for the Apprentice begins on the date the Apprentice starts to work in the applicable trade for the Employer, or as determined by the Director in accordance with the Apprenticeship, Trade and Occupational Certification Act.

The parties to this Contract of Apprenticeship shall comply with the Apprenticeship, Trade and Occupational Certification Act.

This Contract of Apprenticeship comes into effect on the date it is signed by the Director of Apprenticeship, Trade and Occupation Certification.

This contract will be terminated after 12 months of inactivity. I certify that, to the best of my knowledge, the information provided in this document is true and complete in all respects.

Name of Employer: (Please Print)

Signature of Employer: Date: yyyy/mm/dd

APPLICANT/APPRENTICE I have read the instructions, and I hereby make applications for apprenticeship, and I declare that:

1. The information I have provided is true and complete in all respects and that I have not withheld any relevant information.

2. I will notify the nearest ECE Service Centre of any subsequent changes in the information contained on this application.

3. I authorize GNWT, Department of Education, Culture and Employment, to contact other governments, public bodies and education institutions, as well as current and former employers, to verify my certification, education, training and work experience.

4. I authorize GNWT, Department of Education, Culture and Employment, to disclose any personal information obtained from this application, the verification of my certification, and the results of my exams to officials from other Canadian, provincial or territorial apprenticeship jurisdictions for the purpose of determining my eligibility to participate in trade/occupation certification programs.

5. I authorize the GNWT, Department of Education, Culture and Employment, to notify my employer if my application is cancelled, and the reason(s) for the cancellation.

This contract will be terminated after 12 months of inactivity.

Name of Applicant: (Please Print)

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APPRENTICESHIP APPLICATION AND CONTRACT July 2015 Apprenticeship, Trade and Occupation Certification Advanced Education Education, Culture and Employment

Signature of Applicant: Date: yyyy/mm/dd

9. Work and Trades Education Credit(s)

Date registered: yyyy/mm/dd Registered By: Certification Officer Signature

Contract number:

Contract start date: yyyy/mm/dd Contract expected end date: yyyy/mm/dd

Contract requirements:

PLAR Attached? Y/N PLAR Credit Approved? Y/N See below

Level Program Duration

Trades Education Level Credit (PLAR)

Work Experience Credit (hours)

Balance Required Technical Training

Required (Y/N) Examination

Required (Y/N)

APPRENTICESHIP, TRADE AND OCCUPATION CERTIFICATION FEES FORM 2014 Apprenticeship, Trade and Occupation Certification Education, Culture and Employment

APPRENTICESHIP, TRADES AND OCCUPATION CERTIFICATION FEE FORM

________________________________________________________________________________________________________

Apprenticeship and Trade Certification Fees Description of Fees Amount Requested (√)

1. Prior Learning Assessment (PLAR) 100.00

2. Application for Apprenticeship 50.00

3. Progressive Examination 100.00

4. Replacement Record Book 50.00

5. Replacement Certificate (COA, COQ) 50.00

6. Trade Qualification Examination 200.00

7. Supplemental Trade Qualification Examination 50.00

8. Certificate of Qualification 100.00

Total _________

Occupation Certification Fees Description of Fees Amount Requested (√)

1. Application for Occupation Certification 50.00

2. Occupation Examination Fee 50.00

3. Certificate of Competence Fee 100.00

4. Replacement Occupation Certificate 50.00

Total _________

Please check off the requested service in the requested column and enter Total

Client Name _________________________________________________ Date _____________ Client email _____________________________________________ Amount____________ Payment Type (please check) Cash Cheque # Money Order # Journal Entry by GNWT Department (name) Credit Card (VISA/MASTERCARD ONLY). To make a credit card payment, the client must call the Department of Finance

at one of the centres provided on the next page to arrange payment. GNWT/ECE Finance: The account code (71014-44020-01-11-settlement-65009) is to be used when entering in SAM. The community code is to be entered in the “settlement” field in SAM under Accounting Entries-Distribution Lines-ChartFields-Sett. Issue a Cash Drawer Receipt from Accounts Receivable. Cash Drawer/ Receipt Number ______________________________________________________ (Provided by GNWT representative entering in SAM)

CDO: Please include this completed Fee Form and receipt with the appropriate application/certificate request/examination form.

Page 2 of 2

APPRENTICESHIP, TRADE AND OCCUPATION CERTIFICATION FEES FORM 2014 Apprenticeship, Trade and Occupation Certification Education, Culture and Employment

Community Office Street Address Telephone number Type of Payments

Fort Simpson Deh Cho ECE Service Centre

Deh Cho Regional Education Centre

9802-98 Avenue

Box 740 Fort Simpson, NT X0E 0N0

867-695-7335 Cheque/ Cash / Money order

Department of Finance Nahendeh Building

1st Floor 9706-100 St. Fort

Simpson (right across from Northern store)

867-695-7335 Cheque/ Cash / Money

order/Credit Card/Debit

Fort Smith South Slave ECE Service Centres

Sweetgrass Building 177 McDougal Road

Box 1406

Fort Smith, NT X0E 0P0

867-872-7428 Cheque/ Cash / Money order

Department of Finance 182B McDougal Road. Fort Smith

867-872-2450 Cheque/ Cash / Money order/Credit Card/Debit

Hay River Hay River ECE Service

Centre

Court House Building

8 Capital Drive Hay River, NT X0E 1G2

867-874-5050 Cheques/Money Order

Financial Shared Services Suite 211, 62 Woodland Dr.

2nd Floor Wright Bldg.

Hay River, NT X0E 1G1

867-847-2348 Cheque/ Cash / Money

order/Credit Card/Debit

Department of Finance Yellowknife Dept of Finance,

3rd Floor YK Centre

867-873-7527 Cheque/ Cash / Money

order/Credit Card/Debit

Inuvik Beaufort Delta ECE Service Centre

GNWT Multi-Use Building 106 Veterans Way 1st Floor

Bag Service #1 Inuvik, NT X0E 0T0

867-777-7212 Cheque/ Cash / Money order

Department of Finance GNWT Multi-Use Building

106 Veterans Way 3rd Floor

Bag Service #1 Inuvik, NT X0E 0T0

867-777-7456 Cheque/ Cash / Money

order/ Credit Card/Debit

Norman Wells Sahtu ECE Service Centre Edward G. Hodgson Building 1A Raven Road

Box 147 Norman Wells, NT X0E 0V0

867-587-7158 Cheques/Money Order

Department of Finance #8 Town Square (Beside CIBC)

867-587-4567 Cheque/ Cash / Money order/ Credit Card/Debit

Yellowknife North Slave ECE Service

Centre

Nova Plaza, Main Floor

5019-52 Street Box 1320

Yellowknife, NT X1A 2L9

867-766-5112 Cheque/Money order

Department of Finance

(Shared Service)

3rd Floor YK Centre 867-873-7527 Cheque/ Cash / Money

order/ Credit Card/Debit