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1 Step 1
Employment Application for Underground Utilities & Landscaping
Date
Name
Social security number
Date of birth
Address
City/State/Zip
County of residence
Telephone
Cellular telephone
Name and telephone of Person to contact in case Of emergency
Part 2 - Questionnaire
YesNo
1. Are you at least 18 years old?
2. Are you an united states citizen?
or do you have a Residence number #
YesNo
¿Work Permit?
3. Do you have a valid driver's license? (must have valid Driver’s license at time of dispatch)
State issued:
YesNo
4. Do you have reliable transportation?
5. Have you ever been convicted of a felony? (a conviction will not necessarily disqualify you for an employment opportunity.)
6. Do you have a good driving record?
7. Do you have any physical disabilities that may interfere with your performance of the job?
If yes please explain
YesNo
8. Currently employed?
Name of company:
Telephone:
Date available for work
Part 3 - Education and union affiliations, military services
Education
YesNo
Prior union affiliation?
Union name and local #
Give dates
Military services
YesNo
Have you served on active duty in the U.s. armed forces?
Branch of service?
Length of service?

****NOTICE**** IF YOU ARE NOT A U.S. CITIZEN, YOU MUST PROVIDE A COPY OF IMMIGRATION CARD IN ORDER TO BE CONSIDERED FOR EMPLOYMENT. PLEASE PROVIDE COPIESOF SOCIAL  SECURITY CARD, CALIFORNIA DRIVERS LICENSES, AND IMMIGRATIONCARD.

Part 4a - Experience

Please mark areas that you have experience and your level of experience  

NoneLightMediumStrong
Rigging
Diapering of joints
Cutting of holes
Fire watch
Layout irrigation systems
Planting
Working with operators & other trades
Apply insecticide
Cpr certified
Driving trucks
Kickers
Digging
Resurfacing
Grouting
Drain lines
Gas distribution systems
Shooting grades & elevation
Irrigation piping
Plant establishment
Blueprints
Pipe joining
Cribbing & shoring
Backfilling
Sewer
Dry packing
Storm sewers
Cutting torch safety
Drainage
Material take off
Welding
Foreman
Supports
Pipe wrapping
Tamping
Water mains
Part 4b - Prior employment / experience

Please list the last 2 years of employment, starting with the most recent employers.

1.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

2.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

3.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

4.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

5.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

6.

Start date
End date
Employer’s name
Employer’s address
Employer’s telephone
Job title & duties

ALL APPLICATIONS WILL BE RETAINED FOR A PERIOD OF SIXMONTHS. AFTER THAT TIME, THE APPLICANT MUST CONTACT OUR HIRING HALL AND/ORCOMPLETE A NEW APPLICATION. Please note that applicants are not hired based on date ofapplication alone, but rather based on factors such as geographic location,experience, and employer’s needs.

All apprentice applications, please complete the followingquestionnaire. The California Apprenticeship Program, through collection of this data,hopes to improve the apprenticeship program both for those presently enrolled and for futureapprentices. Thank you.

MaleFemale
Gender

Ethnic or Race Derivation (Check Only One)

Dateof appointment
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You can also download this form and send it to:

Underground Utility/Landscape Local 355
13 Tennessee Street, Vallejo, CA 94590
Telephone: 707­644­0355 Fax: 707­644­0360