Construction Registration Form

Teamsters Local 222 CONSTRUCTION Industry

Registration For Employment
Date: *

Month Day Year
Date
(LAST) *
First *
Middle Name *
Cell Number *

Area Code Phone Number
Home: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Social Security Number *
Driver's License: *
State *
Class *
Endorsements *
Birth Date: *

Month Day Year
Date
Are you Registered elsewhere? *
If YES to above Where?
Male or Female (M/F)? *
Are you presently employed? *
If so, Where?
Please List companies you will not or cannot work for: *
I have read the Exclusive Hiring agreement referred to in the Utah Branch, Inc. of the Associated General Contractors of America, Inc. and Teamsters Local Union 222, and I hereby register as provided, and certify that I am qualified to perform the duties required in the classifications checked below, and I am not registered on any other construction list within the geographic area ofthis Agreement.
Signature: *

Clear
List proof of at least two years of actual experience in the building, heavy & highway construction industry:
Classification: *

Articulate Bus Belly Dump Bottle Truck Cement Mixer Challenger/Marooka Dump Truck Flat Rack Trucks Float Foam Truck Forklift Fuel/Oil Tank Trucks Grapple Truck Mechanic with Rig Oil Spreader Operator Semi-Truck Skid Truck Stringer Truck Strong Arm Sweeper or Vacuum Truck Transfer Dump Truck Transport Truck/Lowboy Water Trucks (Conventional) Water Pull Warehouseman Winch/Boom
List any Other Special Experience/Equipment applicable for this industry:
This registration must be accompanied by cash, check, money order, or credit card for the Hiring Hall fee of $16.00as well as a copy of Drivers License, DOT card. Do not mail or fax to Local Union as it will not be accepted without required documentation & fee.
Should be Empty: