Contractor Employment Notification Form
For the Statewide Limited Energy JATC
Please complete and fax to 763-571-5928. Call 763-571-5922 with questions.
EMPLOYEE INFORMATION
NAME:
Social Security #:
ADDRESS:
HOME PHONE:
CELL & PAGER:
CITY
STATE
ZIP
CIRCLE ONE LOCAL UNION ONLY
LOCAL:
110
242
292
BIRTH DATE:
343
HAS NOTICE BEEN FAXED TO UNION:______
EMAIL ADDRESS: __________________________________
POWER LIMITED TECHNICIAN LICENSE #: _________________ EXPIRATION DATE
OR UNLICENSED REGISTRATION #: _________________ OF PLT OR UNLICENSED REG: ___________
FILL IN THIS SECTION FOR ALL NEW HIRES
FILL IN THIS SECTION FOR ALL SEPARATIONS ONLY
DATE OF NOTIFICATION SENT TO JATC:
EMPLOYMENT END DATE:
EMPLOYMENT START DATE:
CIRCLE ONE CLASSIFICATION ONLY
INSTALLER
1
TECHNICIAN
HOURLY RATE
2
3
SENIOR TECH
4
5
REASON FOR TERMINATION
6
JI
JOURNEYMAN TECH
$
__VOLUNTARY QUIT
__DISCHARGE FOR CAUSE
__Reduction In Force
__Probation Period
__REFUSAL OF W ORK
__LABOR DISPUTE
PROVIDE DOCUMENTATION SUPPORTING DISCHARGE FOR CAUSE (ONLY FOR APPRENTICES)
EMPLOYER INFORMATION
EMPLOYING CONTRACTOR:
CONTACT PERSON:
PHONE:
FAX:
JATC OFFICE USE ONLY
50 DAY EVALUATION SENT:
RETURNED:
100 DAY:
DATE RECOMMENDED:
TERMINATION DATE. IF NOT RECOMMENDED:
APTITUDE TEST SCHEDULED:
TEST RESULTS:
SCHOOL:
INDENTURED:
☛CONTRACTORS ☚
Please note, the Statewide Limited Energy JATC is maintaining
“Out of Work” and “Eligible for Hire” reports for the benefit of Contractors and IBEW Members.
Please send notification to JATC on ALL hires and terminations so reports can remain accurate.
★ If you are looking to hire, don’t forget to call for the “Out of Work” & “Eligible for Hire” reports!
OPEIU12