Operating Engineers Local 234

Work Application

Name:

Date:

Address:

Local No.

City

SSN:

Phone No.

State:

E-Mail:

Zip:

Last Employer:

PLEASE READ: The following information will be used for referrals for work.
Mark only the types of work you can do and equipment that you can operate proficiently
enough to be referred on. DO NOT MISREPRESENT YOURSELF. It is YOUR responsibility
to keep the office up-to-date on the following information.This Work Application is not an Apprenticeship Application.
To receive an Apprenticeship Application by mail, please call 641-942-7112.

Types of Work & Years of Experience:

Asphalt Work, Years Experience
Building Work, Years Experience
Concrete Work, Years Experience
Crane Work, Years Experience
Dredge Work, Years Experience
Dirt Work, Years Experience
Distribution Work, Years Experience
Mainline Pipeline, Years Experience
Sand Plants & Quarries, Years Experience
Sewer Work, Years Experience

Licenses and Certifications & Years Held:

CDL, Years held
HazMat Certified, Years held
Trenching & Excavation Safety, Years held
First Aid, Years held
C.P.R. Certified, Years held
OSHA 10 Hour, Years held
Right to Know, Years held
Crane Safety, Years held
CCO, List each below:

Other , Years held

Licenses and Certifications Expiration Dates:

HazMat Certified, Exp.
C.P.R. Certified, Exp.
First Aid, Exp.
Fork Lift, Exp.
CCO, Please list type and Exp. Date below:

OSHA 10 Hour, Exp.

Equipment and Years of Experience (choose R for rough, F for finishing:
Asphalt Roller - Finish
Asphalt Roller - Breakdown
Paver
Screed
Distributor Truck
Plants
Broom
Milling Machine
CMI Subgrader
Pavement Breaker
Finish Machine
Concrete Pump
Conventional Crane
Yard Crane Pipeline
Clam
Dragline
Piledriver
Intrustion Piling
Tower Attachment
Tower Crane
Truck Crane
Hydro, Sm.
Hydro, Lg.
(18 ton or above)
Cherry Picker
Caisson Rig
Derrick Crane
Overhead Crane
Engineer on Dredge
Leverman
License Boat Operator
Deck Hand
Oiler
Safety Boat
Dozer, R F
Motor Grader, R F  
Endloader Track, R F
Endloader Rubber, R F
Cat & Scraper
Motor Scraper
Skidloader
Push Cat
Box Blade
Roller Sheep Foot
Off Road Hauler
Hoe (Track)
Hoe (Rubber Tire)
Hoe Pack
Boring Machine
Pipe Layer
Bending Machine
Ditching Machine
Trencher
Sideboom, Track RT
Skidder
Coating Machine
Wheelebraider Plant
M Scope
Winch Truck
Crusher
Powder Man
Air Tack Drill
Jet Pumps
Switch Locomotive
Fork Lift
Mechanic - Own Rig? Y N
Welder

THIS STATEMENT MUST BE COMPLETED AND SIGNED:
I do not do want my address, phone number and/or social security number released to any person for any purpose other than internal office use.
Signature

HOME PAGE

OPERATING ENGINEERS
LOCAL 234
Main Office
4880 Hubbell Avenue
Des Moines, Iowa
Phone 515-265-1657

 

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