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 13 Other – – – – – – * Transfer to what * 4 Transferred – sponsor: 5 Other Explanation of reason: – 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 Social Security Number Ending Effective Apprentice Name Apprentice ID # Trade Action Reason Last 4 Wage Date Name & Signature of Authorized Representative (Employer/Sponsor) Date Recorded by SAA The information requested in this document may be Send to: PRIVACY ACT STATEMENT: 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 Act Topeka, KS 66612 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 13 – Other * 4 – Transferred * Transfer to what sponsor: 5 – Other Explanation of reason: 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 Last 4 Apprentice ID # Trade Action Reason Ending Wage Effective Date 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-Updated-6.4.18.docx