707-644-0355
Dispatch Request
15371
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Dispatch Request

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Payroll: Please complete for dispatch purpose.

Company Name
Date of Hire
Employee Name
Social Security Number
Address
City/Zip
Telephone
Cell Telephone
Country
Date of Birth
Classification

Note: Apprentices need approval by JATC Coordinator and must sign Apprenticeship Agreement prior to dispatching.

Basis Hourly Wage
Termination Date if no longer employed
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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

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