ࡱ>  :_bjbjVV 4<< HH|4e"0OCCCC2 !!!!!!!#7&^!] !22 ! !!CC",!,!,! ! CC!,! !!,!,!,!C[vY!,!!5"0e",!(,!(,!(,! ! !,! ! ! ! ! !!!,! ! ! !e" ! ! ! !( ! ! ! ! ! ! ! ! !H Q: CR-1 (11/11)NEW JERSEY DEPARTMENT OF TRANSPORTATION DIVISION OF CIVIL RIGHTS APPRENTICE / TRAINEE APPROVAL MEMORANDUMSECTION A: (TO BE COMPLETED BY CONTRACTOR)1.Project: FORMTEXT      2.Contractor: FORMTEXT      Subcontractor: FORMTEXT      3.Apprentice / Trainee Name: FORMTEXT      4.Social Security # (last 4 digits only) FORMTEXT      5.Sex FORMCHECKBOX  Male FORMCHECKBOX  Female6.Training Position: FORMTEXT      7.Hourly Rate:$ FORMTEXT      8.Start Date: FORMTEXT      9.Program Hours FORMTEXT      10.Min. Available Hours: FORMTEXT      11.The candidate is a(n)  FORMCHECKBOX  Apprentice (USDOL Registration Date) FORMTEXT       FORMCHECKBOX  Trainee and  FORMCHECKBOX  does FORMCHECKBOX  does nothave construction experience.12.Check all work categories that the apprentice / trainee has experience in: FORMCHECKBOX  Carpentry FORMCHECKBOX  Electrical FORMCHECKBOX  Ironwork FORMCHECKBOX  Operating Engineer FORMCHECKBOX  Asphalt FORMCHECKBOX  Drilling FORMCHECKBOX  Finishing FORMCHECKBOX  Formsetting FORMCHECKBOX  Grading FORMCHECKBOX  Landscaping FORMCHECKBOX  Pipelaying FORMCHECKBOX  Powertools FORMCHECKBOX  Truck Driving FORMCHECKBOX  Other13.If any items above are checked, complete table below:Work CategoryLength of TimeEmployer FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      14.Is the apprentice / trainee a union member? FORMCHECKBOX  Yes FORMCHECKBOX  No# of Years FORMTEXT      Union Name: FO(*  ^ ` x z    ȸȭleSl#jh:h]vOJQJU h:h03(jh:h)ZOJQJUmHnHu#jh:h]vOJQJUh:h)ZOJQJjh:h]vOJQJUh:h03OJQJh:hzE>*CJOJQJaJ h:hzEh:hzE5CJOJQJaJ h:h?nh:hzEOJQJh:hzECJOJQJaJ "$&( $Ifgdm(*z:... $$Ifa$gd:kd$$Iflִ0 f!R"+]@ } t;,    44 layt:  ^ kb $IfgdmDkd1$$Iflz*P+ t;,44 layt: $$Ifa$gd:Dkd$$Ifl*P+ t;,44 layt:^ ` f x <jkdE$$IflhF*.D% t;,    44 layt: $Ifgd03 $$Ifa$gd:Dkd$$Iflh*P+ t;,44 layt:  . 0 6 p fZ $$Ifa$gd:kd$$Iflhr*., t;,44 layt: $Ifgd03  * , . 0 p r      $ & B D F R T p ޾ެ޾ޏ}hޏޏVޏޏ#jh:h]vOJQJU(jh:hOJQJUmHnHu#jh:h]vOJQJUh:hOJQJ#jh:h]vOJQJUh:h)ZOJQJ h:h03h:h03OJQJ(jh:h)ZOJQJUmHnHujh:h]vOJQJU#jIh:h]vOJQJU   $ R wwww $Ifgd03 $Ifgd $$Ifa$gd:jkd$$IflhF0 *.n  t;,    44 layt:p r t    " $ & D F Z \ ^ h j ޶ޏ޶}ޏv޶dޏ޶#j h:h]vOJQJU h:h03#jCh:h]vOJQJU(jh:h)ZOJQJUmHnHu#jh:h]vOJQJUh:h)ZOJQJh:h03OJQJ h:hh:hOJQJjh:h]vOJQJU#jsh:h]vOJQJU I=44= $Ifgd03 $$Ifa$gd:kd$$Iflh֞f!*.\ T~ t;,44 layt: $ & , D l r Gkd$$Iflhֈf!*..~  t;,44 layt: $Ifgd03 $$Ifa$gd:       J L h j l   "޾޳޾޾޾޳v޾޾d޾޾#j h:h]vOJQJU#j h:h]vOJQJU#j) h:h]vOJQJU h:h03#j h:h]vOJQJUh:h)ZOJQJh:h03OJQJ(jh:h)ZOJQJUmHnHujh:h]vOJQJU#j h:h]vOJQJU#  $$Ifa$gd: $Ifgd03   # $$Ifa$gd:kd $$Iflh 0 #*.}L= t;,$$$$44 layt: J   SJ $Ifgdmkd $$Iflhֈ2 ,"*.p  t;,44 layt: $Ifgd03"#$*+9:;cdefgh ӺӺӊxf#jh:h]vOJQJU#jxh:h]vOJQJU#jh:h]vOJQJUh:h03CJOJQJaJh:h03CJOJQJaJ h:h03#jh:h]vOJQJUh:h03OJQJjh:h]vOJQJU#jYh:h]vOJQJU!*Ecdef] $IfgdmkdA$$Iflhr82 ,*.v t;,44 layt: $Ifgd03efghlbVM $Ifgd03 $$Ifa$gd:BkdL$$Ifl*P+ t;,44 layt: $IfgdmQkd$$Ifl*P+  t ;,44 lap yt: 2 $Ifgd03 $IfgdmWkd$$Iflh0*.") t;,44 layt:2345CDENO]^_ijxyzӺӨӖӄr`#jdh:h]vOJQJU#jh:h]vOJQJU#jh:h]vOJQJU#jbh:h]vOJQJU#jh:h]vOJQJU#jvh:h]vOJQJU h:h03h:h03OJQJjh:h]vOJQJU#j`h:h]vOJQJU%234Niof]]]] $Ifgd03 $Ifgdmkd$$Iflhr ' *. 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FORMCHECKBOX  Approved FORMCHECKBOX  DisapprovedName: FORMTEXT      Date: FORMTEXT      Signature: X4X\XlXXX-kd\%$$Iflhִf!%*.$ ;! 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