ONLINE REGISTRATION FORM - KENNEWICK OFFICE
NOTE: YOU MUST RESIGN MONTHLY BETWEEN THE 10TH AND 16TH OF THE MONTH
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Date and Time (include am or pm): |
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Social Security #: |
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Card #: |
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Classification: |
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Book #: |
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Name: |
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Address: |
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City, State, and Zip: |
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Phone #'s: |
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Email Address: (required) |
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Driver's License: |
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Class of License: |
None Regular CDL Class A CDL Class B |
Endorsements: |
Tanker Double Triple |
Certifications:
List All Other Certifications (Including Line School):
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First Aid/CPR Flagger Card Crane Cert.
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Groundmen: Are You Interested in Tree Jobs? (i.e. Asplundh, Kemp West, Trees, Inc. etc.) |
Tree Jobs URD Tech Jobs |
List Last Employer: |
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Last Employer - City and State: |
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Signature: (By typing your name, you acknowledge you are signing this form.) |
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Only Complete Questions Below If You Are A Member of Another IBEW Local Union. |
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Home Local Union #: |
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Card #: |
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Book #: |
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Dues Paid Thru Date: |
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Home Local Union City and State: |
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Attention! You must upload a copy of your term slip and other certifications. If you do not have a term slip or are new to our Local you must come into the closest Local 77 Union Hall. |
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