Information Card

IBEW LOCAL 234
747 El Camino Real Salinas, CA 93907
831-633-2311
Information Card
Program:*

InsideSound & Comm.CE/CW
Name:*

First NameMiddle NameLast Name
SSN:*
Address:*

Street Address

Street Address Line 2

CityState / 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:*

MonthDayYear
Date
Marital Status:

SingleMarriedDivorced
Gender:

MaleFemale
Race:

American IndianAsianBlackFilipinoHispanicIndianWhiteOther
Are you a member of a Local Union?*
If so, enter your Local Union Number Union number. Please add your Union Card Number Card Number
Are you California State Certified?*

YesNo
California Electrician Licence Number:*
Expiration Date:*

MonthDayYear
Date
Certifications:

GeneralResidentialFire/Life SafetyVDVNon-Res LightingOther
Do you have a California Trainee Card?

YesNo
Licence Number:*
Expiration Date:*

MonthDayYear
Date
Incoming with Employer:*

YesNo
Employer*
Jobsite:*
Please include address or fill out the portability request on our contractor resources page
Start Date:*

MonthDayYear
Date
End Date:

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

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

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: