Apply Your pathway to a sustainable construction career. Register for Work Here "*" indicates required fields Personal DataName* First Middle Last Date of Birth* MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell Phone/Alternate Phone*Email* Person to notify in case of emergency: PhoneGender: (optional) Male Female Race: (optional) African American Caucasian Latino Other Marital Status: (optional) Married Separated Single Divorced Note: These are asked solely for the purpose of meeting federal record kepping requirements and to assist in affirmative action rerarrals requested by an employer.The Laborers' International Union of North America and its affiliates are committed to equal employment opportunity and affirmative action. This hiring hall is administered without regard to race, color, sex, religion, marital status, sexual orientation, national origin, disability, age or veteran status and in accordance with all federal, state and local laws.Can you show two (2) forms of I.D. your prospective employer in order to complete an I-9 form? Yes No Do you have your OWN transportation to and from work? Yes No Do you have a VALID driver's license? Yes No Issued by State of? Do you have a current State Certified ID? Yes No Have you been convicted of a felony? Yes No Is your experience in the Construction Trade? More than 2 years? Less than 2 years? EducationHighest Education Level*SelectGEDHigh SchoolTrade SchoolCollegePlease List Your Past Construction EmployersThe information given on this Standard Registration Form is to be used to determine qualifications for all job referrals within the jurisdiction of Laborers' Local Union in the States of Georgia and South Carolina in compliance with the Laborers' International Union of North America.1, Name of Employer Work Performed/Responsibilities Date of Start MM slash DD slash YYYY End Date MM slash DD slash YYYY Can we contact this employer for verification? Yes No Contact Name Phone Number2, Name of Employer Work Performed/Responsibilities Date of Start MM slash DD slash YYYY End Date MM slash DD slash YYYY Can we contact this employer for verification? Yes No Contact Name Phone Number3, Name of Employer Work Performed/Responsibilities Date of Start MM slash DD slash YYYY End Date MM slash DD slash YYYY Can we contact this employer for verification? Yes No Contact Name Phone NumberSkillsPlease choose the appropriate circle for all skills you are capable of performing. Be prepared to verify, either with documentation or by demonstration, that you can perform the skills checked.* Air & Gas Tamper Air Trac Operator-All Drills Asphalt Raker Backhoe (Rubber Tire or Track) Bobcat Operator Boring/Tunneling Brick Mason Brick Paver Caisson Work Carpenter Tender Chainsaw Chipping Gun Chuck Tender Compactor Concrete Finisher w/o Tools Concrete Finisher w/Tools Concrete Placement Building Concrete Placement Hwy Concrete Saw Man Craft tender, Other Curb & Gutter Cutting & Coring Deckhand Decontamination Demolition Erosion Control Farm Type Tractor Finisher Tender Fire Watch Forklift Form Building / Setting Form Stripping / Wrecking General Laborer Grade Checker Grout man Guardrail / Fence Erection Gunite / Shot Crete HDP Operator / Welder High Scaler Hod Carrier Hydro-Blasting Jackhammer Janitorial Worker Lagging-Underpinning Landscaping Laser Beam Operator Mason Tender Micro-tunneling Horizontal Miner Mortar Mixer Mower Mucking Machine (air) Nuclear Plant Laborer Oxyacetylene Torch Pipe Layer Sanitary Sewer / Strom Pipe Layer Water Pipeline Laborer Plaster Tender Powder Man Powder Man Helper Power Saw Operator Pressure Washer Railroad Work Rebar Tying Sandblaster Sandhog Scaffold Erection Screed Operator Shifter Shoring Hydraulic Signal / Rigging Skid Loader Track Drill Traffic Control Transit Conventional Transit Laser Tunnel Miner Vacuum Truck Vibrator Operator Waterproofing Welding Issued by State of Class Certification No Expires Certification No Expires Certification No Expires Certification No Expires Certification No Expires Certification No Expires Certification No Expires CERTIFIED SKILLS Commercial Drivers License Asbestos Abatement Asbestos Supervisor Asphalt Worker Concrete Placement & Practices Confined Spaces Craft Orientation EMT First Aid / CPS Hazard Communication Hazardous Waste Hazardous Waste Supervisor Lead Abatement Lead Supervisor Lift Operator Passenger Endorsement Line & Grade LIUNA Radiation Worker II Mason Tending Practices & Procedur OSHA 10-Hour Date class taken: OSHA 30-Hour Date class taken: Powder License Principles of Pipe Laying Security Clearance Traffic Control Certification Welding / Certified All certification and documentation for certified skills must be provided at time of interviewWhat are the best day(s) and time(s) to contact you? I certify that all of the information given by me on this registration form is accurate and complete, and that I understand that it is my responsibility to update and keep current the information on this form. Falsification of application will result in complete denial of registration.Applicant Signature Date For Local Union Use Only:Date received: By Mail Yes No Time (if in person): Representative Signature:
