IBEW LU 776 APPLICATION

IBEW 776 APPLICANT INFORMATION

Phone: 843-554-1880 ext.4
Date*

MonthDayYear
Date
Name*
SS#(Last 4 Digits)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Long at address*
E mail Address*
example@example.com
D.O.B.*
Place of Birth*
City, State
Position applying for*
How many yrs have you worked as an electrician?*
Did you serve an Apprenticeship?*

NoYes
Completition of Certificate?*

NoYes
Years attended*

12345
Sponsoring company
Location of Apprenticeship School*
City, State
Have you ever passed an examination given by an IBEW Local Union*

NoYes
Have you ever been certified or ever possessed a journeyman electrician license?*

YesNo
Which of the following phases of electrical installations have you performed?*

Conduit bending and InstallationHydraulic Conduit BendingConcrete Slab InstallationCommercial LightingIndustrial WiringMaintenance & Trouble ShootingControl Wiring
Which of the following phases of electrical installations have you performed?*

Residential WiringSingle HousingCondosApartmentsHigh RiseMaintenance & Trouble ShootingControl WiringType option 8
Which of the following phases of electrical installations have you performed?*

TransformersPLC'sSubstationsHMI'sCable SplicingVDVElectronic ControlsAlarm SystemsOther
Are you currently employed by an electrical contractor?*

NoYes
If work is unavailable within 60 miles from your home, are you willing to travel: 60 - 90 miles from home?*

NoYes
Are you willing to travel 60 t0 90 miles?*

YesNo
Other Areas Of The State?*

YesNo
Out of State*

YesNo
Do you have a valid state drivers license*

YesNo
High School*
Graduated? YesNo
City & State*
College
Graduated? YesNo
Trade School
Graduated? YesNo
List the last three (3) employers (starting with the current or most recent employer), the dates of employment, wage rate, and type of work, or attach resume with above mentioned information.
Employer*
Address
Dates of Employment*

MonthDayYear
Date
Wage Rate*
Type of Work*
Employer
Address
Dates of Employment

MonthDayYear
Date
Wage Rate
Type of Work
Employer
Address
Dates of Employment

MonthDayYear
Date
Wage Rate
Type of Work
By signing this application I affirm that all statements made by me herein are true, complete, and correct to the best of my knowledge and belief, and are made in good faith to assist in determining my proper classification or group in accordance with the referral procedure regulations. I understand that any false statements would be cause for rejection of this application or cause for the removal of my name from the referral list and/or cause me to be discharged from the job.
Signature

Clear
Date

MonthDayYear
Date
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IBEW 776 APPLICANT INFORMATION