Lumen Apprenticeship Application Begin Your Apprenticeship Journey Today Lumen Apprenticeship application Please complete all sections. Information is used to determine eligibility for apprenticeship, workforce funding, and supportive services. 1. APPLICANT INFORMATION Full Name *Date *Address *City *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP Code *Phone Number *Email Address *Preferred Contact MethodSelect OnePhoneTextEmail2. CHOOSE YOUR PROFESSIONWhich apprenticeship are you interested in?Business Development SpecialistDigital Video EditorMarketing CoordinatorSecurity GuardAvailable Start Date * 3. PRIORITY POPULATION SCREENING Are you a Veteran? *YesNoIf yes, Branch of ServiceAre you an Aged-Out Foster Youth? *YesNoAre you experiencing homelessness? *YesNoIf yes, current living situationDo you have a disability? *YesNoIf yes, please identifyAre you receiving public benefits? *YesNoIf yes, which benefits?Are you interested in supportive services? *YesNo 4. EQUAL OPPORTUNITY INFORMATION (OPTIONAL) GenderSelect OneMaleFemaleOthersRace / EthnicitySelect One Providing this information is optional and helps us improve our services. 5. EMERGENCY CONTACT Full Name *Relationship *Phone Number *6. CERTIFICATION I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false or misleading information may result in the disqualification of my application. Date *I agree to the certification above and understand that this electronic signature is the legal equivalent of a handwritten signature. SUBMIT APPLICATION