Transmittal of Actions By Apprenticeship Program Sponsor Section 1 Program Sponsor – Name of Sponsor: Telephone: Fax: Email: Address: City : State: Zip: Instructions: Please use these codes to completed Section 2 below: Action: Reason for Action: 10 Program cancelled by regulatory – 1– Completed 1 Discharged 4 Unsatisfactory performance 7– Transferred to other program – – agency 2 Suspended 2 Accepted related work 5 Lack of work 8– Illness or death 11 Voluntary quit – – – – 3 Cancelled 3 Accepted other work 6 Entered military 9 Program cancelled by sponsor 12 Reason unknown – – – – – * Transfer to what * 4 Transferred – sponsor: PLEASE NOTE: Apprenticeship completion certificates are processed quarterly. A request for Completion of Apprenticeship Certificate implies that the apprentice has met all on-the-job and related instruction requirements. Section 2 - Actions Ending Effective Apprentice Name Social Security Number Apprentice ID # Trade Action Reason Wage Date Print Name & Signature of Authorized Representative (Employer/Sponsor) Date Recorded by SAA Send to: PRIVACY ACT STATEMENT: The information requested in this document may be Kansas Department of Commerce Kansas Apprenticeship Council used for apprenticeship program statistical purposed and may not be otherwise – 1000 S.W. Jackson Street Suite 100 disclosed without the express permission of the above listed apprentices. (Privacy Topeka, KS 66612 Act of 1974 PL93-579) – Revised 2-17-15
Transmittal of Actions By Apprenticeship Program Sponsor Section 1 – Program Sponsor Name of Sponsor: Telephone: Fax: Email: Address: City : State: Zip: Instructions: Please use these codes to completed Section 2 below: Action: Reason for Action: 1– Completed 1 – Discharged 4 – Unsatisfactory performance 7– Transferred to other program 10 – Program cancelled by regulatory agency 2 – Suspended 2 – Accepted related work 5 – Lack of work 8– Illness or death 11 – Voluntary quit 3 – Cancelled 3 – Accepted other work 6 – Entered military 9 – Program cancelled by sponsor 12 – Reason unknown * 4 – Transferred * Transfer to what sponsor: PLEASE NOTE: Apprenticeship completion certificates are processed quarterly. A request for Completion of Apprenticeship Certificate implies that the apprentice has met all on-the-job and related instruction requirements. Section 2 - Actions Apprentice Name Social Security Number Apprentice ID # Trade Action Reason Ending Wage Effective Date Print Name & Signature of Authorized Representative (Employer/Sponsor) Date Recorded by SAA Send to: Kansas Department of Commerce – Kansas Apprenticeship Council 1000 S.W. Jackson Street Suite 100 Topeka, KS 66612 PRIVACY ACT STATEMENT: The information requested in this document may be used for apprenticeship program statistical purposed and may not be otherwise disclosed without the express permission of the above listed apprentices. (Privacy Act of 1974 – PL93-579) Revised 2-17-15
Transmittal-of-Actions.docx