Form 2 of 3
SAMPLE
AT-24 (Rev. 8/03)
JOURNEYPERSON NAMES AND LICENSE TYPES/NUMBERS
JOURNEYPERSON NAME
LICENSE TYPE & NUMBER
John Doe
Fred Doe
Harry Doe
E-1 #000001
E-2 #000002
E-2 #000003
Attach Additional Sheets if Necessary
Doe Electric Inc.
Sponsor Name
1 Main St., Anycity, CT 00000
Street Address, City, State, Zip Code
01-000002
CT Unemployment Tax No.
Signature of Company Official
John Doe, President
8-1-03
Printed Name and Title
Date Signed
The Commissioner of Labor’s Work Training Standards for Apprenticeship and Training Programs (Regulations of Connecticut
State Agencies, Sec. 31-51d (1-12) and Chapter 393 of the Connecticut General Statutes require direct supervision of
apprentices. The Regulations of Connecticut State Agencies, Sec. 20-332-15a (c) specify that “No apprentice shall at any time
engage in any of the work for which a license is required without direct supervision. Direct supervision shall mean under the
guidance of a licensed contractor or journeyperson…” The signer attests that this sponsor will adhere to the apprentice
supervision requirements and that all journeypersons listed above are employed full-time on the job site and are available to
train the sponsor’s apprentices.
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