Suspension Request Form

I,

First Name(Required)

Middle Initial

Last Name(Required)

am registered with CITC’s

Trade:(Required)

apprenticeship program.

My WA State Apprentice ID is:(Required)

Please Enter with 6 Digits.

Click here to lookup your WA State Apprentice ID.

I am requesting to be suspended from the apprenticeship program effective from

From(Required)

to

To(Required)

due to

Suspension reason?(Required)

(Note: if due to medical reasons, please attach doctor’s note below the form.).

I am currently employed by a CITC Training Agent(Required)

contact person(Required)

at

my CITC Training Agent(Required)

When granted a suspension, I realize that none of my on-the-job training hours during my suspension will count towards my apprenticeship.(Required)

Please sign below.

I understand that while on a suspension I cannot work or be employed as an apprentice.(Required)

Please sign below.

I realize that my apprenticeship status will be preserved and protected by requesting and receiving final approval for a suspension from the CITC Apprenticeship Committee.(Required)

Please sign below.

To lift my suspension, I must sign the Out of Work Log prior to my suspension end date. I will receive a letter with the effective dates of my suspension once it has officially been granted by the committee.(Required)

Please sign below.

If I need an extension of my suspension, I must request as extension prior to my suspension end date.(Required)

Please sign below.

Additional Attachments

Doctor's Note (if applicable)

Max. file size: 50 MB.

Today's Date(Required)

Email(Required)

Please enter email to receive a copy of your submission.

CITC Apprentice Suspension Request

Additional Attachments