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Forms

Contractor Name*
Request Made by:*
First Last
Your name
Your Title*
Phone*
Employee*
- New Union Member
- Existing Union Member
- Classification Change
Employer Acknowledgement*
I understand
When hiring a new member with a classification of Journeyperson Installer, Technician, Senior Technician, Journeyperson Technician OR changing a current members classification, supporting documentation shall be provided to warrant such hire or change. Once the documentation is reviewed, you will be notified of any questions or approval. Do not send the applicant in to pick up their referral until approval is received. Per Article 3 – Section 3.05. (b) Wages, Titles and Job Classifications of the Minnesota Limited Energy Agreement.
Insurance
- Local Union Health Benefit Plan
- Employer Provided Plan
Employee Name
First Middle Initial Last
Report Date
MM slash DD slash YYYY
Classification
Address*
Street Address Address Line 2 City State ZIP Code
Email address of new hire*
Phone number of new hire*
Last 4 of SSN*
Date of Birth*
MM slash DD slash YYYY
Email address of person submitting request

A copy of this form will be e-mailed to this address.
Supporting Documents
Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 8 MB, Max. files: 10.
Notes