Floor Coverer Skill Sheet Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Primary phone number*Primary phone type*HomeCellOther phone numberOther phone typeHomeCellEmail UBC ID#*Local Union #*Ethnicity Asian Hispanic Caucasian African-American Native American Other OtherAre you a veteran?YesNoI am a:*JourneymanApprenticeApprentice LevelSkillsYou are skilled/qualified to accept work in these skills:Check all that apply. Bilingual - Spanish (SPANISH) Blueprints (BLUPRNT) Carpet Installation (CARPET) Cleanroom (CLNRM) Computer Floors (COMPFLR) Flash Cove (FLSHCV) Floor Preparation (FLRPREP) Foreman - Commercial (COMFOR) Foreman - Residential (RESFOR) Heat Weld (HEATWLD) Material Handler (MTRLHNDLR) Resilient Floor Installation (RESILIENT) Stretch Carpet (STRETCH) VCT (VCT) Wood Floor Installation (WDFLR) Qualifications/CertificationsThe following qualifications/certifications will be verified through the TRAIN educational system. Please make sure your records are up-to-date. Check all that apply. Aerial Lift (AERLIFT) COIN Certified (COIN) Fall Protection (FALLP) Fall Protection - Residential (FALLPRES) First Aid/CPR (FIRSTAID) Forklift - Industrial (PITOIND) Forklift - Rough Terrain (PITORT) Forbo Certified (FORBO) ICRA 24 (BPHEALTH) INSTALL Carpet Cert (INSTALLC) INSTALL Resilient Cert (INSTALLR) INSTALL Floor Prep Cert (INSTALLFP) Mohawk Master Craftsman (MOHAWK) OSHA 10 (OSHA10) Millwright 16 (MW16) OSHA 30 (OSHA30) Pro 10 (PRO10) Pro-Tech All Cert (PROTEC) Residential Preference Program (RPP) SDS Hazard Communication (MSDS) Steward (STEWARD) Superintendent (SCT) Work areasCheck your PRIMARY work area.*You may only choose one area that you consider your PRIMARY work area. Refer to the area map found at www.northcountrycarpenter.org/mix2020Area 24Area 25Area 26Area 27Area 28Area 29Area 30Area 31Area 32Area 33Area 34Area 35Area 36Area 37Area 38Area 39Area 40Area 41Area 42Area 43Area 44Check any other areas in which you are willing to work.Check as many as apply. Refer to the area map found at www.northcountrycarpenter.org/mix2020. Area 24 Area 25 Area 26 Area 27 Area 28 Area 29 Area 30 Area 31 Area 32 Area 33 Area 34 Area 35 Area 36 Area 37 Area 38 Area 39 Area 40 Area 41 Area 42 Area 43 Area 44 OR: Check here if you are unwilling to travel outside of your PRIMARY work area.Only check this if you are unwilling to travel. I am unwilling to travel outside of my PRIMARY work area Type your name below:*By typing my name below, 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 affiliates, including by auto-dialed or pre-recorded calls. (Please note message and data rates may apply.) I agree that this authorization is in effect 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.