Nuclear Outage

Carpenters Local 277

Nuclear Outage Registration
Name*

First NameMiddle NameLast Name
Address*

Street #

Street Address

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Local#
UBC #*
Journeyman/Apprentice*

JourneymanApprentice 1st yearApprentice 2nd YearApprentice 3rd yearApprentice 4th yearApprentice 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*
Last Date in a Nuclear Facility*

MonthDayYear
Date
Should be Empty: