Registered Apprenticeship Interest Form

*Are you a Career Seeker or an Employer? Career Seeker — I am a career seeker looking for a Registered Apprenticeship. Employer — I am an employer seeking more information about starting a Registered Apprenticeship Program.

Career Seeker Information

*First Name

*Last Name

*Email Address

*Phone Number

*How would you prefer to be contacted? Email Phone Call Text Message

*In what county do you live?

Note: Wayne County — City of Detroit zip codes include the following:

48126, 48201, 48202, 48203, 48204, 48205, 48206, 48207, 48208, 48209, 48210, 48211, 48212, 48213, 48214, 48215, 48216, 48217, 48219, 48221, 48223, 48224, 48225, 48226, 48227, 48228, 48233, 48234, 48235, 48236, 48238, 48240, 48243

*Zip Code

*In what industries are you interested in pursuing with your career? (Select all that apply) Advanced Manufacturing Agriculture and Animal Care Business and Administration Construction Cybersecurity Educational Services Climate/Clean Energy Healthcare Hospitality and Tourism Information Technology Public Service/Government Transportation and Logistics Other

*What other industry interests you? (Please use commas to separate multiple industries)

*Have you earned a GED or high school diploma? Yes No

Employer Information

*Company Name

Business Address

*Street Address

Address Line 2

*City

*County