Fields marked with "*" are required and must be filled out to submit the form.
First Name*:
Last Name*:
Home Local Number*:
Card Number*:
Last Four of Social Security Number*:
Your Email*:
Your Phone Number*:
Your Classification*: Journeyman WiremanJourneyman LinemanCE/CE (Inside)CL (Outside)GroundmanLight OperatorHeavy OperatorOther (List Below) Other Classification (if not listed)
Last Place of Employment (Name of Contractor and Local Union #)*:
Severance(Termination) Date*:
Additional Information (optional)
By clicking here I have read and agree with the dispatch rules and I certify that the above information is complete and correct to the best of my knowledge.
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You will not be added to the books until we receive the required documents.
*Your local union or previous employer may fax documents to: Fax: (806) 376-9407 Attn: Dispatch