IBEW Local 77
International Brotherhood Of Electrical Workers * Seattle, Washington
  • December 04, 2020
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  • Construction Registration Form - Spokane

    ONLINE REGISTRATION FORM - SPOKANE OFFICE 

    NOTE: YOU MUST RESIGN MONTHLY BETWEEN THE 10TH AND 16TH OF THE MONTH

    Date and Time (include am or pm):
    Social Security #:
    Card #:
    Classification:
    Book #:
    Name:
    Address:
    City, State, and Zip:
    Phone #'s:
    Email Address: (required)
    Driver's License:
    Class of License: None    Regular   CDL Class A   CDL Class B
    Endorsements: Tanker   Double   Triple

    Certifications:

    List All Other Certifications - (Including Line School):

    First Aid/CPR   Flagger Card   Crane Cert.

    Groundmen: Are You Interested in Tree Jobs? (i.e. Asplundh, Kemp West, Trees, Inc. etc.) Tree Jobs   URD Tech Jobs
    List Last Employer:
    Last Employer - City and State:
    Signature: (By typing your name, you acknowledge you are signing this form.)
    Only Complete Questions Below If You Are A Member of Another IBEW Local Union.
    Home Local Union #:
    Card #:
    Book #:
    Dues Paid Thru Date:
    Home Local Union City and State:

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