Linemen Registry Today's Date* MM slash DD slash YYYY Union Number* Phone Number*First Name* Last Name* Middle Initial Address* City* State*Select your stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code* Email* CDL License* Yes No License Type* A B Current Medical Certificate* Yes No Clean Driving Record* Yes No Ability to climb poles* Yes No Will you travel for storm work? (Check all that apply)* Yes No Splicing Assessment Pole Setting Primary Are you available for long durations? (Check all that apply)* Yes No Secondary Underground Substation Transmission Current Safety Certifications (Check all that apply)* Pole Top Rescue CPR Bucket Rescue Hazardous Communication Chain Saw Safety Blood Borne Pathogen Personal Protective Equipment First Aid Confined Space 1919.269 Electrical Hazard Awareness MUTCD Traffic Control Use of Insulated Tools Worker Classification* Journeyman Lineman Equipment Operator Groundman Apprentice Other Name Of Other Classification CAPTCHA
