IBEW 575

UNION NEWS

EVENT CALENDAR

IBEW 575 Membership Application

Note that ALL fields are required.

First Name:*

MI:

Last Name:*

Street Address:*

City:*

State:*

Zipcode:*

How Many Years At This Address?:*

Phone Number:*

Cell Number:*

Email Address:*

Last Four of SSN:*

Date of Birth:*

EDUCATION

Are you a high school graduate?

Yes

I received a GED

High School

Name

City

State:*

College

Name

City

State:*

# Of Years Attended:*

List any Degrees Earned

Vocational

Name

City

State:*

# Of Years Attended:*

List any Programs Completed

Are you now, or have you ever been, a registered electrical apprentice? *

Yes

If yes, list apprenticeship program

Are you still active in that program?
Did you complete the program?

If no, when did you leave the program?

Resume Upload:

Certification Upload:

BACKGROUND

Have you served in the US military? *

Yes

Years of Service:*

Service Start Date

Service End Date

Which branch?

List any relevant military work experience

List any relevant military training

Have you ever been convicted of a felony? (A conviction will not automatically disqualify you)

Yes

If YES, explain the conviction

Do you have a valid driver’s license?

Yes

License State:*

License #

Have you ever been a member of the IBEW?

Yes

What was your classification?

Which local?

Starting Date

Ending Date

Card #

Have you ever applied for ANY position (other than listed above) with IBEW Local 575?

Yes

What position did you apply for (JW, CW/CE, apprentice, etc)?

When did you apply?

Do you currently hold an electrical license?

Yes

Electrical License State:*

Electrical License #

WORK HISTORY

Check here if you do NOT have any work experience. Otherwise, please in the form below:

Total Years of Experience in Electrical Construction:

Total Years of Experience that can be documented :

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

Residential:

Commercial:

Industrial:

Other (Specify):

PREVIOUS EMPLOYERS

(List last or current employer first)

Employer

Start Date

End Date

Job Title

Wage/HR

Employer

Start Date

End Date

Job Title

Wage/HR

Employer

Start Date

End Date

Job Title

Wage/HR

Employer

Start Date

End Date

Job Title

Wage/HR

List any certifications

Certification

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

Project

Location

Approximate Start Date Worked

Approximate End Date Worked

Project

Location

Approximate Start Date Worked

Approximate End Date Worked

Project

Location

Approximate Start Date Worked

Approximate End Date Worked

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.

Signature

Date