Please list amount of time worked in each category of electrical construction:

List any certifications

If currently working for an electrical contractor list the last three projects you worked on:

I state that all information provided on this form is true and accurate. I hereby grant permission to contact all former employers and schools listed above to verify the information given, unless I have indicated otherwise. I agree that any false statements made by me on this application form shall constitute grounds for disqualification of my selection or grounds for my discharge, if false information is discovered after being admitted into the union.