Carpenter Nuke/Refinery Form

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Primary Phone Number

Other Phone Number

UBC ID#

Local Union #

Ethnicity

Asian

Hispanic

Caucasian

African-America

Native American

Other

Are you a veteran?

Yes

I am a:

Journeyman carpenter

Apprentice carpenter

Skills

You are skilled/qualiﬁed to accept work in these skills (check all that apply)

Concrete Forms (FORMS)

Foreman - Commercial (COMFOR)

Nuclear Plant Experience (NUKE)

Pile Driver (PILEDRVR)

Reﬁnery Experience (REFINERY)

Sca!old Experience (SCAFEXP)

TWIC card holder (TWIC)

Will work with heights (HEIGHTS)

Signature

By signing my name above, I consent to be contacted via telephone, email, cell phone or text message by the United Brotherhood of Carpenters and Joiners of American and its a"liates, including by auto-dialed or pre-recorded calls. (Please note message and data rates may apply.) I agree that this authorization is in e!ect until I provide written revocation to NCSRCC, 700 Olive Street, Saint Paul, MN 55130. In addition, I declare that the above skills information is correct to the best of my knowledge.

Carpenter Nuke/Refinery Form

Skills

Qualifications/Certifications