Authorized Training Agent Apprenticeship PO Box 44530 Olympia WA 98504-4530 Date Effective Date L&I Apprenticeship Consultant Termination Name Employer Address City State Zip Code Contact Person Name Contact Phone Number Contact Email Contact Fax Number Contractor ID Number (if applicable) UBI Number Name of Registered Apprenticeship Program Occupation(s) The Employer understands and agrees that participation is voluntary. Failure to adhere to the requirements for apprenticeship established under RCW 49.04, Chapter 296-05 WAC, and 29 CFT Parts 29 and 30 could result in the cancelation of the and its ability to participate in the apprentice program. employer’s agreement For the Employer For the Apprenticeship Program Signature Signature Name Printed Name Printed Title Title Date Date For L&I Apprenticeship Use Only ARTS Assigned Employer ID # Date Entered in ARTS
Apprenticeship PO Box 44530 Olympia WA 98504-4530 Authorized Training Agent Effective Date Termination Date L&I Apprenticeship Consultant Employer Name Address City State Zip Code Contact Person Name Contact Phone Number Contact Email Contact Fax Number Contractor ID Number (if applicable) UBI Number Name of Registered Apprenticeship Program Occupation(s) The Employer understands and agrees that participation is voluntary. Failure to adhere to the requirements for apprenticeship established under RCW 49.04, Chapter 296-05 WAC, and 29 CFT Parts 29 and 30 could result in the cancelation of the employer’s agreement and its ability to participate in the apprentice program. For the Employer For the Apprenticeship Program Signature Signature Printed Name Printed Name Title Title Date Date For L&I Apprenticeship Use Only ARTS Assigned Employer ID # Date Entered in ARTS