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Youth Apprenticeship Form – Employer Interest
Youth Apprenticeship Program
Employer Interest Form – Ag-Industrial Maintenance Technician (High School)
Contact Information
This is a 2,000 Hour Apprenticeship Program. The employer is both the employer of record and responsible for wages, taxes and benefits.
(Please complete all sections. This helps us increase quality during the apprenticeship recruitment.)
Name of Contact Person
(Required)
First
Last
Title of Contact Person
(Required)
Phone
(Required)
Email
(Required)
Business/Agency
(Required)
Address
(Required)
Street Address
City
ZIP Code
Worksite Location
(Required)
Same as Address Above
Street Address
City
ZIP / Postal Code
About the Position
Title of Position
(Required)
Number of Positions Available
(Required)
Requested Start Date
(Required)
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Starting Hourly Wage
(Required)
Please enter a number from
16.9
to
100
.
Please note: $16.90 per hour is CA Minimum wage starting 1/1/2026
Is there Opportunity for Pay Increases?
(Required)
Yes
No
Please note: An apprenticeship requirement is that the apprentice receives at least one pay increase either during or at the successful completion of the 2,000 hour apprenticeship.
If yes, please describe the opportunity for the pay increase below
(Required)
Minimum Age
(Required)
16
17
18
Other
Desired Work Schedule When School is in Session
(Required)
(10–25 hours/week)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Desired Daily Work Schedule
(Required)
Desired Participant Work Schedule During School Breaks & Summer
(Required)
(17 year old = up to 48 hrs/week; 18 year old = no cap)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Desired Daily Work Schedule (Summer)
(Required)
Do you Require any Pre-Employment Screening
(Required)
(Check all that apply)
Pre-Employment Drug Screen
Pre-Employment Physical
Reasonable Suspicion Drug Screen
Post-Incident Drug Screen
Random Drug Screen
For the Interview Process, What do you Prefer
(Required)
(check all that apply)
Round 1 is an in-person panel interview, hosted at Department of Education, with your business and hiring managers from other participating employers. Round 2 interview is hosted at your business.
Round 1 is hosted in-person by staff from your company only, no other businesses present.
What day of the week is best for in-person interviews for this position
(Required)
(check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Position Description
Primary Duties
(Required)
(age-appropriate and supervised)
Supervision
Supervisor's Name
(Required)
First
Last
Title
(Required)
Phone
(Required)
What experience, knowledge, or benefit will the supervisor bring to the program
(Required)
Limitations or Requirements
Describe any Limitations or Requirements Below
(Required)
(Include PPE, age, uniform, tools, work attire, etc.)
Anything Else We Should Know
Name of Person Submitting this Form
(Required)
First
Last
Consent
(Required)
By checking the box below, I confirm that I am an authorized representative of the company listed in this application.
Confirm
Date
(Required)
Month
Day
Year
