Union Potential Member Application - Carpenters Local 792

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Local 792 Potential Member Application

MID-AMERICA CARPENTERS REGIONAL COUNCIL
UNITED BROTHERHOOD OF CARPENTERS AND JOINERS OF AMERICA
LOCAL UNION NO. 792
212 South First Street, Rockford, IL 61104-2089
Phone: (815) 963-8675 / Fax (815) 963-0208
Email: [email protected]

Union Questionnaire

Date

Trade for which you are applying

Carpenter Floor Covering Other

First Name

Middle Name

Last Name

Street Address

City

State

Zip

Mobile Phone Number

Home Phone Number

Email

Personal Information

Are you at least 17 years of age?

Yes No

Are you legally permitted to work in the U.S.?

Yes No

Education

1) High School Name and Location

Last Full Year Attended

9 10 11 12

2) College Name and Location

Last Full Year Attended

1 2 3 4 5 6

Major

Degree

3) College Name and Location

Last Full Year Attended

1 2 3 4 5 6

Major

Degree

Military Service

Were you in the military?

Yes No

Enlistment Date

Discharge Date

Branch of Service

Army Navy Air Force Marines National Guard

Did you take any of the following subjects in school?

Math Shop Drawing Blueprint Reading Building Trades

Other Training

List any other training you have received such as Trade School, Company training courses, Independent training, military training, etc. List any additional experiences, skills or qualifications that you feel would be applicable.

Why have you chosen this trade as your career?

Employment History
(List most recent position first)

Employer 1:

Employer Name

Dates Employed

Employer Street Address

City

State

Zip

May we contact this employer for a reference?

Yes No

Employer Phone Number

Name and title of last supervisor:

Your current or last position and duties:

Reason(s) for leaving:

Current or last rate of pay (hourly):

Starting rate of pay (hourly):

Employer 2:

Employer Name

Dates Employed

Employer Street Address

City

State

Zip

May we contact this employer for a reference?

Yes No

Employer Phone Number

Name and title of last supervisor:

Your current or last position and duties:

Reason(s) for leaving:

Current or last rate of pay (hourly):

Starting rate of pay (hourly):

Employer 3:

Employer Name

Dates Employed

Employer Street Address

City

State

Zip

May we contact this employer for a reference?

Yes No

Employer Phone Number

Name and title of last supervisor:

Your current or last position and duties:

Reason(s) for leaving:

Current or last rate of pay (hourly):

Starting rate of pay (hourly):

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