Organizing Membership Application Step 1 of 2 50% Name*First, Middle Initial, Last Address, City, State, Zip,phone number*How long have you lived at current address?*What is your e-mail Address?*Date of Birth and Place of Birth?*How many years have you worked as an electrician?*Did you serve an Apprenticeship?* Yes No If yes did you finish and earn a Completion Certificate?* Yes No How many years of Apprenticeship did you complete?* One Year Two Years Three Years Four Years Five Years List the location of Apprenticeship School by Name, including City & State*Have you ever passed an examination given by an IBEW Local Union?* Yes No Have you ever been certified or ever possessed a journeyman electrician License?* Yes No Which of the following phases of electrical installations have you performed? Check all that apply.* Conduit Bending & Installation Rigid Conduit EMT PVC Hydraulic Conduit Bending Concrete Slab Installation Commercial Lighting Industrial Wiring Control Wiring Residential Wiring Single Housing Condos Apartments High Rises Hotels Undergoround Dist Overhead Line Work Till-Ups Supervision Transformers Substations Cable Splicing Electronic Controls PLC's HVI's VDV Alarm Systems Other Are you currently employed by an electrical contractor?* Yes No If work is unavailable within 60 miles of you home, are you willing to travel to go to work?* Yes No Are you willing to travel out of state to work as an electrician?* Yes No Do you have a Valid State drivers' license?* Yes No Do you have a Valid Louisiana State drivers' license?* Yes No List what High School you attended?*Did you Graduate?* Yes No If you did not graduate did you earn a GED?* Yes No Have you attended any trade school or community college?*If yes did you Graduate?* Yes No Name the City and State?* 1. Employer:*Address:*Dates of Employment:*Wage Rate:*Type of Work:*2. Employer:*Address:*Date of Employment:*Wage Rate:*Type of Work*3. Employer:*Address*Dates of Employment:*Wage Rate:*Type of Work*Name First Last By Signing this application or submitting this application for consideration by electronic means, 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. PhoneThis field is for validation purposes and should be left unchanged.