First Name:
*
Last Name:
*
Address:
*
City, State:
, AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY *
Zip Code:
*
Phone:
*
E-Mail Address:
*
Emergency Contact (Name, Relationship, Phone):
How many years of verifiable experience do you have operating, servicing, and/or maintaining heavy equipment?:
*
How many of those years are current in Colorado?:
*
Do you have a valid driver's license?: Yes: No: *
Do you have a commercial driver's license?: Yes: No: *
Class: *
A:
B:
C:
NO CDL:
CDL Endorsements: *
TANKER (N ENDORSEMENT)
HAZMAT (H ENDORSEMENT)
HAZMAT/ TANKER (X ENDORSEMENT)
NO CDL OR NO ENDORSEMENTS
Do you have any restrictions on your Driver License?: *
Yes: No:
Driver License Issuing State: *
AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY No License:
Driver License Expiration Date: *
No License:
Do you have a current CDL physical?: *
Yes: No:
Do you now, or have you ever belonged to an IUOE Local?: Yes: No: *
If so, from which local?:
If so, from what dates?:
to
If so, what is your registration number?:
How did you hear about IUOE Local 9?: *
Briefly state the areas of your experience (examples: Heavy/Highway, Building,
Utility, General Earthmoving): *
Starting with the most recent, please list the employment history for the LAST 3 YEARS OF RELEVANT OPERATING,MECHANIC, OR DRIVING EXPERIENCE (This can include employment beyond the last 3 calendar years). Only include employment history where you performed work operating, maintaining, or repairing equipment or drove commercial vehicles. The contact person should be someone from the Human Resources Department or Management: (If a disclosure statement is required to release the information, it will be your responsibility to obtain one) YOU MUST LIST CONTACT NAMES AND PHONE NUMBERS THAT CAN BE REACHED TO VERIFY YOUR EMPLOYMENT HISTORY. APPLICATIONS WITHOUT CONTACTS WILL NOT BE PROCESSED. WE WILL NOT CONTACT CURRENT EMPLOYERS. *
1. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
2. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
3. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
4. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
5. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
6. EMPLOYER NAME & ADDRESS:
Date Employed From:
Date Employed To:
Employer Contact Name & Number:
Type of work performed:
Equipment Operated:
List the years of experience and/or certifications with the applicable equipment listed. IF YOU DO NOT HAVE EXPERIENCE WITH THE PIECE OF EQUIPMENT, PLACE "0" : *
Loader:
Scraper:
Backhoe:
Trackhoe:
MiniEx:
Dozer:
Finish Dozer:
Rough-Blade:
Finish-Blade:
Telehandler:
Truck/Haul:
Pipeline (various):
Grade-Check:
Utility Work:
Working Foreman:
Rigging/Signal:
Crane Operator (list tonnage and type along with year(s) experience as well as NCCCO certifications):
By submitting this form, I attest that the information I have provided is true and correct to the best of my knowledge. I further understand that incomplete applications or false statements will result in the rejection of my application. I also understand that submission of this application does not guarantee admission into any program offered by IUOE Local 9 or guarantee acceptance of membership.
* Required Fields