ࡱ> %` <bjbj o̟̟G2 $Xd777P784fS:Vj?j?j?j?E@D1F 1R3R3R3R3R3R3R$ThVnWRLE@E@LLWRj?j? SANANANLj?j?1RANL1RANANANj?: @x]7 MANN6S0fSANV%M VANVAN\=GrHANIJb=G=G=GWRWR1N=G=G=GfSLLLL 77D(,T  Appendix B APPRENTICESHIP AGREEMENT AND APPRENTICE ELECTRONIC REGISTRATION MANUAL Program Registration and Apprenticeship Agreement Office of ApprenticeshipU.S. Department of Labor Employment and Training Administration APPRENTICE REGISTRATION-SECTION II OMB No. 1205-0223 Expires: 10/31/2008Warning: This agreement does not constitute a certification under Title 29, CFR, Part 5 for the employment of the apprentice on Federally financed or assisted construction projects. Current certifications must be obtained from the Office of Apprenticeship (OA) or the recognized State Apprenticeship Agency shown below. (Item 22)The sponsor and apprentice agree to the terms of the Apprenticeship Standards incorporated as part of this Agreement. The sponsor will not discriminate in the selection and training of the apprentice in accordance with the Equal Opportunity Standards in Title 29 CFR Part 30.3, and Executive Order 11246. This agreement may be terminated by either of the parties, citing cause(s), with notification to the registration agency, in compliance with Title 29, CFR, Part 29.6PART A: TO BE COMPLETED BY APPRENTICE. NOTE TO SPONSOR: PART A SHOULD ONLY BE FILLED OUT BY APPRENTICEName (Last, First, Middle) and Address *Social Security Number (No., Street, City ,State ,Zip Code) (Voluntary - See reverse)  FORMTEXT     -  FORMTEXT    -  FORMTEXT       FORMTEXT      Answer Both A and B (Voluntary) (Definitions on reverse) 4. a. Ethnic Group (Mark one)  FORMCHECKBOX  Hispanic or Latino  FORMCHECKBOX  Not Hispanic or Latino b. Race (Mark one or more)  FORMCHECKBOX  Am. Indian or Alaska native  FORMCHECKBOX  Asian  FORMCHECKBOX  Black or African American  FORMCHECKBOX  Native Hawaiian or other Pacific Islander  FORMCHECKBOX  White5. Veteran Status (Mark one)  FORMCHECKBOX  Non-Veteran  FORMCHECKBOX  Veteran6. Education Level (Mark one)  FORMCHECKBOX  8th grade or less  FORMCHECKBOX  9th to 12th grade  FORMCHECKBOX  GED  FORMCHECKBOX  High School Graduate  FORMCHECKBOX  Post Secondary or Technical Training2. Date of Birth (Mo., Day, Yr.)  FORMTEXT      3. Sex (Mark one)  FORMCHECKBOX  Male  FORMCHECKBOX  Female7. Career Linkage or Direct Entry (Mark one) (Instructions on reverse)  FORMCHECKBOX  None  FORMCHECKBOX  Adult  FORMCHECKBOX  Youth  FORMCHECKBOX  HUD/STEP-UP  FORMCHECKBOX  School-to-Registered-Apprenticeship  FORMCHECKBOX  Incumbent Worker  FORMCHECKBOX  Job Corps  FORMCHECKBOX  Dislocated Worker  FORMCHECKBOX  Direct Entry: FORMTEXT       8. Signature of Apprentice Date  FORMTEXT        FORMTEXT      9. Signature of Parent/Guardian (if minor) Date  FORMTEXT        FORMTEXT      PART B: TO BE COMPLETED BY SPONSOR10. Sponsor Program No.  FORMTEXT       Sponsor Name and Address (No. Street, City, County, State, Zip Code)  FORMTEXT      11a. Trade/Occupation (The work processes listed in the standards are part of this agreement).  FORMTEXT      11b. Occupation Code  FORMTEXT      12. Term (Hrs., Mos., Yrs.)  FORMTEXT        FORMDROPDOWN 13. Probationary Period (Hrs., Mos., Yrs.)  FORMTEXT        FORMDROPDOWN 14. Credit for Previous Experience (Hrs., Mos., Yrs.)  FORMTEXT        FORMDROPDOWN 15. Term Remaining (Hrs., Mos., Yrs.)  FORMTEXT        FORMDROPDOWN 16. Date Apprenticeship Begins  FORMTEXT      17a. Related Instruction (Number of Hours Per Year)  FORMTEXT      17b. Apprentice Wages for Related Instruction  FORMCHECKBOX  Will Be Paid  FORMCHECKBOX  Will Not Be Paid17c. Related Training Instruction Source  FORMTEXT      18. Wages: (Instructions on reverse)18a. Pre-Apprenticeship Hourly Wage $  FORMTEXT       18b. Journeyworker s Hourly Wage $ FORMTEXT       18c. Apprentice s Entry Hourly Wage $ FORMTEXT      Period 1234567891018d. Term  FORMDROPDOWN  (Hrs., Mos., Yrs.) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      18e. Wage Rate (Mark one) %  FORMCHECKBOX  or $  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      19. Signature of Sponsor s Representative(s) Date Signed  FORMTEXT        FORMTEXT      21. Name and Address of Sponsor Designee to Receive Complaints (If applicable)  FORMTEXT      20. Signature of Sponsor s Representative(s) Date Signed  FORMTEXT        FORMTEXT      PART C: TO BE COMPLETED BY REGISTRATION AGENCY22. Registration Agency and Address  FORMTEXT      23. Signature (Registration Agency)  FORMTEXT      24. Date Registered  FORMTEXT      25. Apprentice Identification Number (Definition on reverse):  FORMTEXT       Item 4.a. Definitions: Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, Spanish origin, can be used in addition to Hispanic or Latino. Item 4.b. Definitions: American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as Haitian or Negro can be used in addition to Black or African American. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Item 7. Instructions: Indicate any career linkage (definitions follow) or direct entry. Enter None if no career linkage or direct entry apply. Enter Incumbent Worker if the individual before becoming an apprentice was currently employed full-time by the sponsor or entities participating in the apprenticeship program. Career linkage includes participation in programs that provided employment, training and other services to adults, youth and dislocated workers. Funds for these activities are provided by the U.S. Department of Labor/Employment and Training Administration to states and local communities. Adult. Also includes individuals participating in Native American Programs, and/or Migrant and Seasonal Farmworker Programs. Youth. Includes Youth ages 16-21 years, and other concentrated Youth programs in designated areas. Dislocated Worker. Includes an individual that has been terminated or laid off and is unlikely to return to the industry or occupation. It also includes a displaced homemaker who has been providing unpaid services to family members in the home, is no longer supported, and is unemployed or underemployed. Job Corps. Youth ages 16-24 years usually receiving services in a residential setting. School-to-Registered Apprenticeship. Program designed to allow high school youth ages 16 - 17 to enter a Registered Apprenticeship program and continue after graduation with full credit given for the high school portion. HUD/STEP-UP. Developed in conjunction with the U.S. Department of Housing and Urban Development (HUD). The program provides the actual apprenticeship experience and the framework for moving into high-skill Registered Apprenticeship. Direct Entry. A graduate from an accredited technical training school, Job Corps training program or a participant in a military apprenticeship program, any of which training is specifically related to the occupation and incorporated in the Registered Apprenticeship standards. Also, fill in the name of the program. Item 18. Wage Instructions: 18a. Pre-Apprentice hourly wage, sponsor enters the individuals hourly wage in the quarter prior to becoming an apprentice. 18b. Journeyworkers wage, sponsor enters wage per hour. 18c. Apprentices entry hourly wage, (hourly dollar amount paid), sponsor enters this apprentices entry hourly wage. 18d. Term, sponsor enters in each box the apprentice schedule of pay for each advancement period. 18e. Percent or dollar amount, sponsor marks one. Note: 18b. If the employer is signatory to a collective bargaining agreement, the journeyworkers wage rate in the applicable collective bargaining agreement is identified. Apprenticeship program sponsors not covered by a collective bargaining agreement must identify a minimum journeyworkers hourly wage rate that will be the basis for the progressive wage schedule identified in item 18e. of this agreement. 18d. The employer agrees to pay the hourly wage rate identified in this section to the apprentice each period of the apprenticeship based on the successful completion of the on-the-job learning and the related instructions outlined in the Apprenticeship Standards. The period may be expressed in hours, months, or years. 18e. The wage rates are expressed either as a percent or in dollars and cents of the journeyworkers wage depending on the industry. 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" """$"&"("2"4"6"8"L"N"P"Z"\"^"`"t"v"x"""""""ܺܺܺܺܺܺܺr_r%jh_hqCJOJQJU^Jh_hqCJOJQJ^J%j8hqCJOJQJU^J%jh8hqCJOJQJU^J%j7hqCJOJQJU^JhqCJOJQJ^J*jhqCJOJQJU^JmHnHujhqCJOJQJU^J%j|7hqCJOJQJU^J""""" #####(#*#,#6#8#:#<#P#R#T#^#`#b#d#x#z#|#####ʺʤʺʎxʺbxʺOxʺ%j>hqCJOJQJU^J+jr>h1hqCJOJQJU^J*jhqCJOJQJU^JmHnHu+j>h1hqCJOJQJU^J+j=hG hqCJOJQJU^JjhqCJOJQJU^JhqCJOJQJ^J%jh_hqCJOJQJU^J+j=hG hqCJOJQJU^J###################$$$$$$&$($*$,$@$B$D$N$P$R$T$h$ѻѻѻѻoѻ%j*AhqCJOJQJU^J%j@hqCJOJQJU^J%j>@hqCJOJQJU^J%j?hqCJOJQJU^J*jhqCJOJQJU^JmHnHujhqCJOJQJU^J%jR?hqCJOJQJU^JhqCJOJQJ^J$##$*$R$z$$$%%h%%& & K$y&`#$/Ifgdq $y&`./Ifgdq $y&`#$/If^gdq $y&`#$/IfgdqFfC$$y&`#$/Ifa$gdq h$j$l$v$x$z$|$$$$$$%%%.%0%2%<%>%@%B%V%ܺܺܺzdNzz*jhqCJOJQJU^JmHnHu+j*FhwhqCJOJQJU^JhqCJOJQJ^JjhqCJOJQJU^J h\hqCJOJQJ^JaJ%jBhqCJOJQJU^JhqCJOJQJ^J*jhqCJOJQJU^JmHnHujhqCJOJQJU^J%jAhqCJOJQJU^JV%X%Z%d%f%h%& & & &"&$&.&0&&&&&&&&&ٷu_Nٷ8+j\IhwhqCJOJQJU^J h\hqCJOJQJ^JaJ*jhqCJOJQJU^JmHnHu+jZGh1hqCJOJQJU^JhqCJOJQJ^JjhqCJOJQJU^JhqCJOJQJ^JhqhqCJOJQJ^J*jhqCJOJQJU^JmHnHujhqCJOJQJU^J+jFh1hqCJOJQJU^J &2&4&&&T>> $y&`#$/IfgdqkdxH$$If4x0,&(`&$ 6`y0L,2+22+2:44 al$y&`#$/If^lgdq&&&&&&&&&&Z'''''''''(w_G62hq h/;hqCJOJQJ^JaJ.jhqCJOJQJU^JaJmHnHu/j7LhU%hqCJOJQJU^JaJ hU%hqCJOJQJ^JaJ)jhU%hqCJOJQJU^JaJhq5CJOJQJ\^JhqCJOJQJ^J*jhqCJOJQJU^JmHnHu+jIh1hqCJOJQJU^JjhqCJOJQJU^JhqCJOJQJ^J&&&&Z'GkdJ$$If4x0,&( &$ 6`y0L,2+244 a$y&`#$/Ifgdq $y&`#$/If^gdqZ'\'''((xfP>f$y&`#$/Ifgdq$y&`#$/If^gdq$y&`#$/Ifgdqkd^K$$If(,&L,  6`y 0L,22H44 ap (((,(.(0(:(<(>(h(j(~(((((())$)&)()2)4)6)8):))**|++x,,5-^---6.L.001$1112ؖ؀|u|u|u|u|u|u|u|u|u|u| hq5\hq+jNh<hqCJOJQJU^J+j#Mh1hqCJOJQJU^J*jhqCJOJQJU^JmHnHu+jLh1hqCJOJQJU^JhqCJOJQJ^JjhqCJOJQJU^JhqCJOJQJ^J.(>(f(h(($y&`#$/If^gdq$y&`#$/Ifgdq$y&`#$/If^gdq((6)fP w$y&`#$/IfgdqkdM$$IfXF$,& &&e 6`y0L,    244 a6)8):)h)**wpYE 0^`0gdq$ #^#`a$gdqgdq$ ^ `a$gdqwkdJO$$IfB,&L, 6`y0L,2+244 a*|+x,5--6.L.0112 3346/666\77 $ a$gdq$ ^`a$gdq  gdq$ #^#`a$gdq$ ^`a$gdq22 3/333446/63666[7\777T;{;|;;;;;;;;;;;;;;;bżƼμϼ׼ؼ!<QνнS±hqCJOJQJ^JaJ h|hqCJOJQJ^JaJ hdrhqhdrhq5\hk/hqmH sH Uhq5>*\ hq\h1Ohq\hq hq5\@7779:T;|;;Mbd  H(#`'AAAAAA0^`0gdq  H(#`'AAAAAA0^`0gdq 0^`0gdq$ #^#`a$gdq$ #^#`a$gdq$ ^`a$gdq $ <a$gdq hrs., mos., yrs. 1000 hrs. 1000 hrs. 1000 hrs. 1000 hrs. 1000 hrs. 1000 hrs. % 55 60 65 70 80 90 Example - 4 YEAR APPRENTICESHIP PROGRAM Term Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Period 8 hrs., mos., yrs. 6 mos. 6 mos. 6 mos. 6 mos. 6 mos. 6 mos. 6 mos. 6 mos. % 50 55 60 65 70 75 80 90 Item 25. Definition: The apprentice identification number is a unique number generated by the Registered Apprenticeship Information System (the OAs database), which is used to identify the apprentice. It replaces the social security number to protect the apprentices privacy. *The submission of your social security number is voluntary. For purposes of the Davis Bacon Act of 1931, as amended, U.S. Code Title 40, Sections 276a to 276a-7, and Title 29 CFR 5., your social security number will be used to verify and certify to the U.S. Department of Labor, Employment Standards Administration, that you are a registered apprentice to ensure that the employer is complying with the geographic prevailing wage of your occupational classification. It will be used to verify your periods of employment and wages for purposes of complying with Memorandum M-02-06 of the Office of Management and Budget related to the Presidents Management Agenda for performance and budget integration of Federal Programs. Your response is voluntary. Failure to disclose your social security number on this form will not affect your right to be registered as an apprentice. Civil and criminal provisions of the Privacy Act apply to any unlawful disclosure of your social security number, which is prohibited.The collection and maintenance of the data on ETA-671, Apprentice Registration Section II Form, is authorized under the National Apprenticeship Act, 29 U.S.C. 50, and Code of Federal Regulations 29 Part 29.1. The data is used for apprenticeship program statistical purposes and is maintained, pursuant to the Privacy Act of 1974 (5 U.S.C. 552a.), in a system of records entitled, DOL/ETA-4, Apprenticeship Information Management System (AIMS), which is now known as the Registered Apprenticeship Information System at the Office of Apprenticeship, U.S. Department of Labor. Data may be disclosed to a State Apprenticeship Council to determine an assessment of skill needs and program information, and in connection with federal litigation or when required by law.Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Apprenticeship, 200 Constitution Avenue, N.W., Room N-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0223).     ؼ!<QSK $$Ifa$gdq$ #^#`a$gdq  gdq @ x X $0^`0gdq @ x X $0^`0gdqKLLM,'fkdP$$If   '+ t0   +44 a $$Ifa$gdqfkd P$$If   '+ t0   +44 a q+-./124578;<hz'8jhz'8UhW h0HfhqCJOJQJ^JaJ h|hqCJOJQJ^JaJhqCJOJQJ^JaJ,-.0134679:;<gdEvfkd,Q$$If   '+ t0   +44 a 901hP:pq/ =!"#$ % 21h:pEv/ =!"#$% <Dd X0  # A2=϶܌\xĦD`!=϶܌\xĦ-8 Zx흽nAg_I 1BQDXt Q##KI(-{ DI$Xvױ Ǿη5;~yhQ'#fYi~|=G[6;[7 ]1/$DM]L莺jRy~$޶[3f)VrnOSYev5}N,gVNi-=Z,5)i̚gqη5I58Kj(PWcovzzl}ԗU%^t.ФWNp8}t|C{"'u)֔ozt6\_rˤ7~K;\wp$apx!MAR(%BaT!e ) BEBV+FRGg9#d?dϟ x,`_qFprmBFID>TC8 B2 BL[Rѝ{(PykX"\U*a~RœEay[Md` F?pfm7#u`@XIin0ɤ5|.C2 Ҷǂ=m>R{ca ONva Ww38**|zU =5'vwI^o4G_P(~E#aJ{!x(<"|uA/$_9"UCKôCh"DA/ev|1>!YdO у}u><$-)R,Egɲ/jre(eHXV V(~OGfS{o6|Mq(x+A64Plyi/GE_ԐW u`/L'# Q#i:D(so<W ~:XʉK0~:xO/zi| O(WNJ.7¢@Q4txЪzgXX1F֔2SfY֩VT67ֳf<[Eڣ5guӨ( $$If!vh555#v#v#v:V  6`y0L,5559/  / / / 2H4 4$$If!vh5L,#vL,:V  6`y0L,,5L,9/ / 4 4$$If!vh55#v#v:V  6`y0L,559/ 2+2 :4 4$$If!vh5L,#vL,:V (  6`y 0L,,5L,92V24 4p |DText71###zDText75##~DText76####DText1 UPPERCASE:Enter the apprentice's name and address (5 lines maximum).tDeCheck3tDeCheck3tDeCheck5tDeCheck6tDeCheck7tDeCheck8tDeCheck9vDeCheck10vDeCheck11$$If!vh55W 5; #v#vW #v; :V 4 6`y0L,++55W 5; 92+222:4 4vDeCheck12vDeCheck13vDeCheck14hDevDeCheck15$$If!vh55W 5; #v#vW #v; :V 4 6`y0L,+++55W 5; 92+2:4 4DText2 MM/dd/yyyy2Enter the apprentice's date of birth as MM/DD/YYYYtDeCheck1tDeCheck2$$If!vh5 55W 5; #v #v#vW #v; :V 4 6`y0L,++5 55W 5; 92+24 4vDeCheck16vDeCheck18vDeCheck20vDeCheck22vDeCheck26vDeCheck17vDeCheck19vDeCheck21vDeCheck23tDText3$$If!vh5L,#vL,:V 0 6`y0L,5L,92+24 4vD2Text39DText40 MM/dd/yyyyEnter Date as MM/DD/YYYYvD2Text41DText42 MM/dd/yyyyEnter Date as MM/DD/YYYY$$If!vh55#v#v:V 4x 6`y0L,5592+22+24 4f4$$If!vh5L,#vL,:V (  6`y 0L,,5L,92V4 4p D Text4 UPPERCASE|D UPPERCASEjD$$If!vh55#v#v:V 4 6`y0L,+5592+224 4tDText7tDText8Df Dropdown1 Hrs.Mos.Yrs.tDText9Df Dropdown2 Hrs.Mos.Yrs.$$If!vh55553 #v#v#v#v3 :V 4 6`y0L,+55553 922+24 4vDText10Df Dropdown3 Hrs.Mos.Yrs.D Text117box 12 (Term) - box 14(Credit) = box 15(Term Remaining)Df Dropdown4 Hrs.Mos.Yrs.DText12 MM/dd/yyyyEnter date as MM/DD/YYYY.$$If!vh555W5e#v#v#vW#ve:V 4 6`y0L,+555W5e922+24 4jDvDeCheck24vDeCheck25DText14 UPPERCASE2Enter Related Instruction source (4 line maximum).$$If!vh5 55v#v #v#vv:V 0 6`y0L,5 55v9/ 24 4$$If!vh5L,#vL,:V  6`y0L,,5L,9/ / 224 4DText73##.##DText35##.##DText36##.##$$If!vh5L,#vL,:V  6`y0L,,5L,9/ / 224 4d$$If!v h555555555 5 5 #v#v :V ( 6`y0L,55 9 / / /  /  / / 224 4hkdP0$$If( m J'!$e(,&&&&&&&&&&& 6`y0L,,,,,2244 aDf Dropdown5 in Hrs.in Mos.in Yrs.jDjDjDvDText59vDText58vDText59vDText58vDText59vDText58vDText59\$$If!v h555555555 5 5 #v#v :V P 6`y0L,, 55 9 / / / /  / 224 4hkdT9$$IfP m J'!$e(,&&&&&&&&&&& 6`y0L,,,,,2244 avDeCheck27vDeCheck28jDjDvDText68vDText69vDText68vDText69vDText68vDText69vDText68vDText692$$If!v h555555555 5 5 #v#v :V P 6`y0L,, 55 9 / / 224 4hkdB$$IfP m J'!$e(,&&&&&&&&&&& 6`y0L,,,,,2244 avD2Text43DText44 MM/dd/yyyyEnter Date as MM/DD/YYYYDText37TEnter name and address of person designated to receive complaints (5 lines maximum).$$If!vh5(5$#v(#v$:V 4x 6`y0L,+5(5$92+22+2:4 4vD2Text45DText46 MM/dd/yyyyEnter Date as MM/DD/YYYY$$If!vh5(5$#v(#v$:V 4x 6`y0L,+5(5$92+24 4$$If!vh5L,#vL,:V (  6`y 0L,,5L,922H4 4p vDText74vDText47DText48 MM/dd/yyyyEnter Date as MM/DD/YYYY$$If!vh5 55e#v #v#ve:V X 6`y0L,5 55e9/ 24 4D Text49 UPPERCASE$$If!vh5L,#vL,:V B 6`y0L,5L,9/ 2+24 4$$If!vh5+#v+:V t0   +5+44 a$$If!vh5+#v+:V t0   +5+44 a$$If!vh5+#v+:V t0   +5+44 aL@L qNormal1$7$8$H$CJ_HaJmH sH tH @ + Heading 3S$$ /: V &r*!$ `1$@&^ ``a$ 56CJOJQJ\]^JaJ$DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k(No List4@4 [Header  !4 @4 [Footer  !LOL q671 & #$./1$7$8$H$ CJOJQJlO"l q671 Instructions" ! x^` CJOJQJ^JFO!2F q 671 Details^`JB@BJ q Body Text1$7$8$H$CJOJQJ^Jj@Sj q Table Grid7:V0FV`aF #%eFollowedHyperlink >*B* phU2; !z!z!z zhl(U2 349:QefghBCijR#LMk2OPno 1hi, - a b   ( ) V W  $ & ; < = Q Z m n   E X k l =>]^,@Th|&:NbvTefz{3Gkl +}lJ5t !G!! 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