Referral Application Please enable JavaScript in your browser to complete this form.Applicant InformationLast 4 SSN *Name *FirstMiddleLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Gender--MaleFemalePrefer not to answerEthnicity--American Indian or Alaska NativeAsian or Pacific IslanderBlack/African AmericanHispanic or LatinoWhite/CaucasianTwo or More RacesPrefer not to answerDate of Birth *Email *US Citizen--YesNoNon-Citizen, Authorized to Work in the U.S.Additional Information Position--Groundman (No Experience Required)Operator (Must submit 4,000 operating hours)Lineman (Must submit 10,000 hours)Upload Verification of Hours Drag & Drop Files, Choose Files to Upload You can upload up to 8 files. Please upload documentation from previous employer(s) on company letterhead verifying your classification and total hours worked. Documentation must include your job classification, dates of employment, total hours worked, and be signed by an authorized company representative. All submitted hours are subject to review and approval by the Business Agent. Operator Applicants: Documentation must also include the types of equipment Please upload documentation from previous employer(s) on company letterhead verifying your classification and total hours worked. Documentation must include your job classification, dates of employment, total hours worked, and be signed by an authorized company representative. All submitted hours are subject to review and approval by the Business Agent. Operator Applicants: Documentation must also include the types of equipment operated and the number of operating hours on each piece of equipment operated. copies Phone Ethnicity Drivers License--Standard Driver License (Non-CDL)CDL Class ACDL Class BNo Valid Driver LicenseCertificationsCPRFirst AidCable SplicerConfined SpaceCrane CertificationFlaggerHazmat EndorsementOSHA 10OSH 20OSHA 30Tanker EndorsementTWICWelderUpload Drivers License & Certifications * Drag & Drop Files, Choose Files to Upload EducationHigh School NameYears AttendedCertificate/DegreeCollege/TechnicalYears Attended Certificaiton/DegreeHave you served in an apprenticeship--YesNoThird ChoiceIf yes, where and how long?Have you ever been an IBEW member?--YesNoUpload copies of any relevant technical school, apprenticeship, or trade certifications. Drag & Drop Files, Choose Files to Upload You can upload up to 5 files. Previous EmployementPlease list your employment history beginning with your current or most recent employer. Include all relevant employers.Employer 1City, StateJob Title/ Kind of WorkDates Employed Employer 2City, StateJob Title/ Kind of Work Dates Employed Employer 3 City, StateJob Title/ Kind of Work Dates EmployedEmployer 4City, State Job Title/ Kind of WorkDates EmployedDisclaimer and Signature * Clear Signature I certify that my answers are true and complete to the best of my knowledge, and are made in good faith to assist the hiring hall in determining my proper group classification in accordance with the referral procedure regulations and that any false statement would be cause of rejection of application, removal of name from referral list, and or discharge from job. Electronic Signature: In accordance with federal law, applicants may sign electronically-equaling to the same degree as a handwritten signature- by using the following process. The applicant must fill in name and date below, and check the Electronic Signature box.Submit
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