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Application for Membership Statement
*
I hereby agree to forfeit all monies paid by me, along with all right to membership, if any of my answers are found to be untruthful, and further to accept and abide by the law set forth in the Constitution and By-Laws of this International.
I Agree
Applying for membership as
*
AI - Apprentice/Improver
HH - Hazardous Material Handler Helper
SI - Specialty Improver
JM - Journeyman Mechanic
SM - Specialty Mechanic
PW - Production Worker
HM - Hazardous Material Handler Mechanic
FM - Firestop Mechanic
FH - Firestop Helper
CM - Commercial Applicator Mechanic
CH - Commercial Applicator Helper
IM - Intermediate Mechanic
QC - Quality Control
PERSONAL INFORMATION
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Suffix
Marital Status
Single
Married
Divorced
Seperated
Widowed
Widower
Gender
*
Male
Female
Birth Date
*
MM slash DD slash YYYY
MAIL TO INFORMATION
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Cell Phone
Fax
Email
ADDITIONAL INFORMATION
Length of trade experience, if any
Where spent
Firm where last employed
Ever a member of our International Association
Yes
No
If so, what Local Union
If indebted to said union, in what amount
Status
Lapsed
Expelled
Apprenticeship Cancelled
Date
MM slash DD slash YYYY
Ever rejected by vote of union
Yes
No
If so, what Union
Date
MM slash DD slash YYYY
MILITARY INFORMATION
Were you ever in the Armed Forces
Yes
No
If so, which branch
Army
Air Force
Canadian Forces
Coast Guard
Marines
National Guard
Navy
Have you ever registered with the Helmets to Hard Hats program
Yes
No
If so, when
MM slash DD slash YYYY
TERMS AND CONDITIONS
*
This application will be actively considered for six months after it is filed. For consideration after that time a written request for reactivation is required. I authorize an inquiry to be made on the information contained in this application. Upon written request the nature and scope of this inquiry will be made available to me. Former employers named herein are authorized to give information regarding me. They are hereby released from all liability for issuing such information. I understand and agree that my employment is for no definite period and may regardless of the date of payment of my wages be terminated at any time without any previous notice. Either party may terminate the employment relationship at any time, with or without cause and with or without advance notice.
I AGREE
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