Business Representative Application | Northern Midwest Regional Council of Carpenters

First Name

Middle Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Local Union

How long have you been a member of the UBC?

Date of Birth (mm/dd/yyyy)

Please submit any supplemental materials here (resume, cover letter, additional comments).

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Education

Name of High School

City/Town

State/Province

ZIP/Postal Code

Country

Did you graduate High School?

Yes

I have my GED

Name of College

City/Town

State/Province

ZIP/Postal Code

Country

Number of years attended:

College Degree completed:

College courses taken:

Name and location of apprenticeship/trade school:

Did you graduate apprenticeship/trade school?

Yes

Courses taken at apprenticeship/trade school:

Military or additional training (including any Labor Studies or Safety Training):

Employment & Experience

Company Name (most recent):

Length of Employment (date range):

Contact Person First and Last Name:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Contact Person Phone:

Position Held:

Reason for Leaving:

Company Name:

Length of Employment (date range):

Contact Person First and Last Name:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Contact Person Phone:

Position Held:

Reason for Leaving:

Essay

What do you feel you can contribute to improve this union? (50 words or less)

What would you tell a non-Union worker about the Union? (50 words or less)

Please write a brief statement in regard to what you have done to help build our union in the last year:

References

Reference 1 First and Last Name:

Reference 1 Phone:

Reference 1 Occupation:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Reference 2 First and Last Name:

Reference 2 Phone:

Reference 2 Occupation:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Reference 3 First and Last Name:

Reference 3 Phone:

Reference 3 Occupation:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Have you ever had any driving violations in the last five years?

Yes

Have you been convicted or served any part of a prison term for the above enumerated crimes?

Yes

Anything else we should know about you?

By signing your name in the box above: I DECLARE ALL IN FORMATION IN THIS DOCUMENT IS TRUE AND COMPLETE. I UNDERSTAND INFORMATION CONTAINED IN THIS APPLICATION MAY BE VERIFIED AND I RELEASE THE NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS FROM ANY LIABILITY WHATSOEVER BY REASON OF REQUESTING INFORMATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR ARE GROUNDS FOR DIMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY BE TERMINATED FOR CAUSE OR WITHOUT CAUSE AT ANY TIME .

Signature

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