Information Card

IBEW LOCAL 234
10300 Merritt St.
Castroville, CA 95012
831-633-2311
Information Card
Program:

Inside Sound & Comm. CE/CW
Name: *

First Name Middle Name Last Name
SSN: *
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone: *
Please enter a valid phone number.
Home Phone:
Please enter a valid phone number.
Email: *
example@example.com
Emergency Contact Name:
Emergency Contact Phone:
Please enter a valid phone number.
Birth Date: *

Month Day Year
Date
Marital Status:

Single Married Divorced
Gender:

Male Female
Race: *

American Indian Asian Black Filipino Hispanic Indian White Other
Local Number:
Card Number:
Did you graduate High School in the Monterey Bay Area?

Yes No
Name of High School:
Are you California State Certified?

Yes No
Card Number: *
Expiration Date: *

Month Day Year
Date
Certifications:

General Residential Fire/Life Safety VDV Non-Res Lighting Other
Do you have a California Trainee Card?

Yes No
Card Number: *
Expiration Date: *

Month Day Year
Date
Incoming with Employer:

Yes No
Employer
Jobsite:
Start Date:

Month Day Year
Date
End Date:

Month Day Year
Date
I agree to share the information above, including my social security number, with the IBEW Local 234.
Your Signature: *

Your SSN will be kept secure and not shared outside the use of the Information Card Clear
Date: *

Month Day Year
Date
Hour Minutes AM/PM Option
Should be Empty: