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Department of Workforce Development
Bureau of Apprenticeship Standards
APPRENTICE APPLICATION - VOLUNTARY DISCLOSURE FORM
The information requested on this form is voluntary and gathered for compliance with state and federal affirmative action regulations governing
registered apprenticeship programs [Wis. Admin. Code § DWD 296.11 and Code of Federal Regulations Title 29 Part 30.11]. The information you
provide will be utilized by your program sponsor and state and federal apprenticeship staff for program administration, but may also be used for
reporting purposes [Privacy Law, s. 15.04(1)(m), Wis. Stats].
SELECT ONE:
Yes, I have a disability (or previously had a disability)
No, I don't have a disability
PLEASE COMPLETE:
Date
Name
Date of Birth
Why are you being asked to complete this form?
It is unlawful for a sponsor of a registered apprenticeship program to discriminate against an apprentice or
applicant on the basis of disability. However, because of your status as an apprentice or apprentice
applicant, you are being given the opportunity to disclose if you have a disability, or ever had a disability.
This form is used to evaluate the inclusion of individuals with disabilities in registered apprenticeship
programs. Because disability status may change or a person may wish to update their previous status, the
opportunity to disclose a disability is given during the application process, at the time of registration as an
apprentice, and on an annual basis during the apprenticeship. There is no penalty for disclosing a disability
now that you previously did not disclose.
How do I know if I have a disability?
You may be considered to have a disability if you have a physical or mental impairment or medical condition
that makes achievement unusually difficult, limits your ability to work, substantially limits a major life activity,
or if you have a history or record of such an impairment or medical condition. Disabilities include, but are
not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS,
schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing
limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obsessive compulsive disorder,
impairments requiring the use of a wheelchair or intellectual disability.
Apprentices: Return this form to your sponsor or mail it to the address below.
Sponsors: Enter this form into BASERS or submit it to your ATR or the address below.
Bureau of Apprenticeship Standards
Attn: AA/EEO
P.O. Box 7972
Madison, WI 53707
DETA-18736-E (N. 12/2019)