ETP Enrollment
Name
*
First Name
Last Name
Email
*
example@example.com
Last 4 of Social Security
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Local Union
*
Classification
*
Journeyman Wireman
Apprentice
Type option 3
CWOT 7
CW 6
Other
Age Group
*
Less than 25
25-34
35-44
45-64
65 and over
Ethnicity (select one)
*
Asian
Black
Filipino
Hispanic
Native American
Pacific Islander
White
Other
Education (select one)
*
Eight Grade or Less
Some High School
High School
GED
Some College
College Graduate
Post College Graduate
Sex
*
Male
Female
Employer
*
Hire Date
*
Veteran (select one)
*
Yes
No
Date of Service
Disabled (select one)
*
Yes
No
Wage
*
Submit
Should be Empty: