APPLICANT INFORMATION
Full Name: Street Address:
Apartment # City: State: Zip Code:
Home Phone # Cell Phone # E-mail:
Date of Birth: Place of Birth:
Social Security # Date Available:
Are you a citizen of the United States? YES NO
If no, are you authorized to work in the U.S.? YES NO
Have you ever been a member of the IBEW? YES NO If yes, when?
Have you ever been convicted of a felony or a misdemeanor? YES NO
If yes, explain when and why:
EDUCATION
High School: Address:
From: To: Did you Graduate? YES NO
College: Address:
From: To: Did you Graduate? YES NO Degree:
Other: Address:
From: To: Did you graduate? YES NO Degree:
WORK HISTORY
Heavy Industrial Schools Outside Transmission
Commercial Controls Outside Distribution
Residential Fire Alarm Outside Substation
Service VDV Line Clearance
Other (please specify)
PREVIOUS EMPLOYMENT
Company: Company Phone #
Address: Supervisor:
Job Title: Starting Salary:
Ending Salary: From: To:
Reason for Leaving:
Responsibilities:
MILITARY SERVICE
Branch: From: To:
Rank at Discharge: Type of Discharge:
If other than honorable, explain:
PLEASE COMPLETE THE FOLLOWING QUESTIONNAIRE:
Have you ever been a member of any other Union other than the IBEW? YES NO
If so, which Union? When and where?
Are you employed in the electrical trade? YES NO
How long have you been in the electrical trade?
Please list any special skill or training below (such as Journeyman Card, Vocation Training, Apprenticeship, etc.)
Do you have employer sponsored health care? YES NO
List names of three (3) IBEW Local 80 members if possible who have knowledge of your skills, working ability, etc. below
If you are accepted, will you take an active part in IBEW Local 80? YES NO
What is the reason for joining IBEW Local 80? Health Care
Wages Retirement Training
Safety Working Conditions Advancement
How did you hear about IBEW Local 80?
