Application for Membership

Personal Information

Name *

Address 1 *

Address 2

City *

State *

ZIP code *

Address *

Home Phone Number

Mobile Number *

Email Address *

Are you a U.S. Citizen? *

Yes

Have you ever been convicted of a felony? *

Yes

Date of Birth *

Month

Day

Year

Gender *

Current Employer *

If selected for membership, are you willing to submit to a drug screening test? *

Yes

Upload Resume *

More information

Files must be less than 2 MB.
Allowed file types: pdf.

Upload Most Recent Paystub *

More information

Files must be less than 2 MB.
Allowed file types: pdf.

Electrical Background

Do you hold a Massachusetts Electrical License? *

Yes

Electrical License No. *

Years of Experience? *

Have you been employed as a Foreman or General Foreman? *

Foreman

General Foreman

Union Affiliations

Have you ever been a member of a Union? *

Yes

Name of Union *

Years of Membership *

Education

School Name *

Location *

Years Attended *

Degree Received *

Major *

School Name

Location

Years Attended

Degree Received

Major

References

Name *

Title *

Company *

Phone *

Name *

Title *

Company *

Phone *

Employment History

Company *

Job Title *

Dates Employed *

Work Phone *

Starting Pay Rate *

Ending Pay Rate *

Address 1 *

Address 2

City *

State *

ZIP code *

Address *

Company

Job Title

Dates Employed

Work Phone

Starting Pay Rate

Ending Pay Rate

Country

Address 1

Address 2

City

State

ZIP code

Address

Signature Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to membership, I understand that false or misleading information in my application or interview may result in my release.

Full Name *

Date *

Month

Day

Year

Signature (full name) *

Leave this field blank

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