CECWApplication

Date* First Name* Last Name* Address* How Long at Address?*

Phone* Email* Date of Birth* Place of Birth*

Position Applying For:* How many years have you been an electrician?* Did you serve an Apprenticeship?* Yes No Completion Certificate?* Yes No

Years Attended* Sponsoring Company* Location of Apprenticeship School*

Have you ever passed an examination give by an IBEW Local Union?* Yes No Have you ever been certified or ever possessed a journeyman electrician license?* Yes No Do you have a state drivers' license?* Yes No

Are you currently employed by an electrical contractor?* Yes No If work is unavailable within 60 miles from your home, are you willing to travel:* 60 to 90 miles away from your home. other areas within the state. out of state. Not willing to travel.

High School:*

City & State*

Graduated HS?* Yes No

College:

Graduated College? Yes No

Trade School:

Graduated Trade School? Yes No

Most Recent Employer* Employer Address:* Dates of Employment:* Wage Rate:*

2nd Most Recent Employer Employer Address: Dates of Employment: Wage Rate:

3rd Most Recent Employer Employer Address: Dates of Employment: Wage Rate:

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By signing this application I affirm that all statements made by me herein are true, complete, and correct to the best of my knowledge and belief, and are made in good faith to assist in determining my proper classification or group in accordance with the referral procedure regulations. I understand that any false statements would be cause for rejection of this application or cause for the removal of my name from the referral list and/or cause me to be discharged from the job.*

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