NATIONAL IRONWORKER'S TRAINING PROGRAM                                                        FOR AMERICAN INDIANS  IMPORTANT:  This form must be signed by the applicant and returned before registration is complete.  The objective of this training program is to prepare Native Americans to join an Ironworker local union as an apprentice, and to finish the apprenticeship to become a Journeyman Ironworker. Becoming an Ironworker would provide a well paying career for the graduate.  Starting wages for apprentices range from $14.00 to $20.00 per hour plus fringe benefits.  Journeyman wages range from $23.00 to $38.00 per hour depending on the area the graduate is placed.    PLEASE READ THE FOLLOWING STATEMENTS PERTAINING TO THE PROGRESSION OF THE TRAINING PROGRAM.  This course will last 11 weeks, Monday through Friday, 8:00a.m. To 4:00p.m. Each student receives a stipend of $205 per week for hotel and living expenses. Hotels will cost $125 per week, per person. ( double occupancy) Proper tools, work boots, and safety equipment will be supplied during training. Training will consist of : Orientation to the Ironworker trade, OSHA safety courses, union history and orientation, blueprint reading with related math, trade science, rigging, welding, oxy-acetylene cutting, re-bar installation and structural steel erection. As the course is completed you will be placed as an apprentice ironworker at an agreed upon location. Fact you should know Drug testing is mandatory prior to starting this program and as an apprentice. Construction sites may not be accessible to public transportation, therefore: Most unions require a valid driver’s license and a means of transportation prior to starting as an apprentice. Please include a copy of your license with this form. If you do not have one include an explanation as to when one will be obtained. As the apprenticeship is started the necessary tools are forwarded to the Local Union for the graduate of the program as long as the placement occurs within 6 months of completion of the course. Please sign below to indicate you have read and understand the objectives of the National Ironworkers Training program for American Indians.  ______________________________      ________                 Applicant’s Signature                               Date     ________________________________      Print name Above

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NATIONAL IRONWORKERS TRAINING PROGRAM FOR AMERICAN INDIANS                                                         PHYSICAL EXAMINATION FORM 1.       Name:_______________________________________________________   Telephone:____________________________         Address:_____________________________________ City/State/Zip _____________________ 2.       Date of Birth:____________ Sex_________ Race____________ WT. ______ HT______________ 3.       What kind of work or training is contemplated? ____________________________________________________ 4.       Previous Employment (Dusty work, lead, chemicals, etc. ) ____________________________________________ ____________________________________________ 5.       Past medical history: Illness, surgeries, lung diseases, Bone injuries, Back strains, blood clots,ect. ____________________________________________________________________      Applicants Signature: ____________________________________________________________  (N)  Indicates Normal or negative findings 6.       Pulse Rate ________  Resp. Rate _________     Blood Pressure       S__________  D _________ 7.       Eyes:  Vision      Right eye ___________    Left eye __________________   Glasses __________ 8.       Ears: ___________  Hearing  Right  _________  Hearing Left_____________ 9.       Throat:_____________ Tonsils______________ Teeth_____________Thyroid _____________ 10.   Lungs: ________________________________________________________________________ 11.   Heart: ________________________________________________________________________ 12.   Abdomen:_____________________________________________________________________ 13.   Nervous System:________ _______________________________________________________ 14.   Back (spine): ________________  Flexion___________________Extension___________________________ 15.   Skin: _________________________________Varicose Veins ___________________________   16.   Hernia:__________________________________________________________________________ 17.   Extremities: ( Deformities, Limitations of motion) ____________________________________________________ 18.   Laboratory: (urine, Blood)         Albumin _________________  Sugar _________________________       19.  Individual has been tested for drugs:  Positive____________ Negative _______________ 20.   Physically qualified: ____________________ Physically Disqualified:_____________________    Remarks and Recommendations: _________________________________________________________________________________   EXAMINING PHYSICIANS SIGNATURE: _______________________________________________________________________ Date: _______________                         Name, address and phone # of Clinic or Hospital ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

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