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Carpenters Local 277
Nuclear Outage Registration
Name
*
First Name
Middle Name
Last Name
Address
*
Street #
Street Address
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Local#
UBC #
*
Journeyman/Apprentice
*
Journeyman
Apprentice 1st year
Apprentice 2nd Year
Apprentice 3rd year
Apprentice 4th year
Apprentice 5th year
Plants you have worked at
*
Yes
No
9 Mile #1
9 Mile #2
Fitzpatrick
Ginna
Personal Information
*
Yes
No
Are you currently red badged
Is your UBC scaffold card certification valid
Do you have an OSHA 10 card
Are you a US Citizen
New to Nuclear
*
Please Select
Yes
No
Last Date in a Nuclear Facility
*
-
Month
-
Day
Year
Date
Submit
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