Organized Journeyman Application

Organized Journeyman Application
Have you spoken with an agent of Local 47 before filling this out?

YesNo
I/We make the following statement at the close of business on this day

MonthDayYear
Date
I hereby agree to forteit all monies paid by me, along with all right to membership, if any of my answers are found to be untruthful, and further to accept and abide by the law set forth in the Constitution and By-Laws of this International.
Do you agree with this statement?

I agreeI disagree
Applying for membership as:

Apprentice/ImproverHazardous Material Handler HelperSpecialty ImproverJourneyman MechanicSpecialty MechanicProduction WorkerHazardous Material Handler MechanicFirestop MechanicFirestop HelperCommercial Applicator MechanicCommercial Applicator HelperIntermediate MechanicQuality Control
PERSONAL INFORMATION
Prefix
First Name
Middle Name
Last Name
Suffix
Nickname
Title/Initials
Spouse Name
Social Security Number
Gender

MaleFemale
Marital Status

SingleMarriedDivorcedWidowedWidowerSeparated
Birth Date

MonthDayYear
Date
Mail to Information
Address
City/Town
State/Province
Zip/Postal Code
County
Country
Email Address
Home Phone
Work Phone
Cell Phone
Fax Number
Additional Information
Length of trade experience, if any
Where spent
Firm where last employed
Ever a member of our International Association

YesNo
If so, what Local Union?
Reason for leaving

LapsedExpelledApprenticeship Cancelled
When did you leave said union?
It indebted to said union, in what amount?
Ever rejected by vote of union?

YesNo
If so, what Union?
When were you rejected by said union?
MILITARY INFORMATION
Were you ever in the Armed Forces?

YesNo
If so, which branch?

ArmyNavyMarinesAir ForceCoast GuardNational GuardCanadian ForcesOther
Have you ever registered with the Helmets to Hard Hats program?

YesNo
If so, when?
EDUCATION INFORMATION

Education Background

	School Name	Course of Study	Last Year Completed	Graduate?	Diploma/Degree
Elementary
High School
College
Other

Employment Information
Present Employer, Name, Address
From
To
Reason for L.eaving
Job Title
Department
Supervisor
Describe the work that you did
Phone
Wages $
per
Previous Employer, Name, Address
From
To
Reason tor Leaving
Job Title
Depanment
Supervisor
Describe the work that you did
Phone
Wages $
per
PERSONAL REFERENCES
Name
Address
Phone
Occupation
Name
Address
Phone
Occupation
Name
Address
Phone
Occupation
Authorization

This application will be actively considered for six months after it's filed. For consideration after that time, a written request for reactivation is required. I authorize an inquiry to be made on the information contained in this application. Upon written request, the nature and scope of this inquiry will be made available to me. Former employers named herein are authorized to give information regarding me. They are hereby released from all liability for issuing such information. I understand and agree that my employment is for no definite period and may regardless of the date of payment of my wages be terminated at any time without any previous notice. Either party may terminate the employment relationship at any time, with or without cause and with or without advance notice.
Date

MonthDayYear
Date
Signature

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Should be Empty:

Organized Journeyman Application

PERSONAL INFORMATION

Mail to Information

Additional Information

MILITARY INFORMATION

EDUCATION INFORMATION

Employment Information

PERSONAL REFERENCES