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Name: *

E-Mail Address: *

Address

Street *

City *

State *

Zip Code *

Length of time at current address *

Phone Number *

Date of birth *

City and State of birth *

Position applying for *

How many years have you worked as an electrician? *

Did you serve an apprenticeship? *

Yes No

Did you receive a completion certificate? *

Yes No

How many years did you attend?

Which company sponsored you?

Location of apprenticeship school

City

State

Have you ever passed an examination given by an IBEW Local Union? *

Yes No

Have you ever been certified or possessed a journeyman electrician license? *

Yes No

Which of the following phases of electrical installations have you performed?

Conduit bending & Installation
Rigid
EMT
PVC
Hydraulic conduit bending
Concrete slab installation
Commercial lighting
Industrial wiring
Maintenance & troubleshooting
Control wiring
Residential wiring
Single housing
Condos
Apartments
High rises
Hotels
Underground dist.
Overhead line work
Tilt-ups
Supervision
Transformers
Substations
Cable splicing
Electronic controls
PLC's
HMI's
VDV
Alarm systems
Other

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 from home? *

Yes No

Other areas within the state? *

Yes No

Out of state? *

Yes No

Do you have a state drivers' license? *

Yes No

Education and Work History
Education

High School *

Graduated?

City & State *

College

Degree

Graduated?

Trade School

Specialty

Graduated?

Employer 1

Employer

Dates of Employment

Wage Rate

Type of Work

Employer 2

Employer

Dates of Employment

Wage Rate

Type of Work

Employer 3

Employer

Dates of Employment

Wage Rate

Type of Work

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