Official UBC application **/****

United Brotherhood of Carpenters and Joiners of America

Membership Application

1) Local/Affiliate: 2) Social Security Number/SIN: 3)

Last Name Sr,Jr First Name M Nickname

4)

Address City State/Province Zip/Postal Country

5) 6)

Telephone Date of Birth (MM/DD/YYYY)

7) Classification: Applicant Pre-apprentice Apprentice Member 8) Craft: Choose an item (click here).

9)

Home Phone Cellphone Fax

Other phone E-Mail

Obligation

I do, of my own free will and accord, solemnly and sincerely promise, on my sacred honor, that I will never reveal by word or deed any of the business of this United Brotherhood unless legally authorized to do so. I promise to abide by the Constitution and Laws, and the will of the majority, observe the By-Laws and Trade Rules established by Local Unions and Councils affiliated with the Brotherhood and that I will use every honorable means to procure employment for brother and sister members. I agree that I will ask for the Union label and purchase union-made goods and employ only union labor, when same can be had. And I further agree that if, at any time, it should be discovered that I have made misstatements as to my qualifications for membership – I shall be forever debarred from membership and donations in this order. I pledge myself to be obedient to authority, orderly in the meetings, respectful in words and actions and charitable in judgement of my brother and sister members. To all of this I promise and pledge my most sacred word and honor to observe and keep, and the same to bind to me, as long as I remain a member of this Brotherhood. And I further affirm and declare that I am not now affiliated with, and never will join or give aid, comfort or support to any organization that tries to disrupt any Local Union, District Council, Regional Council, State or Provincial Council or the International Body of the United Brotherhood of Carpenters and Joiners of America. Being admitted to membership, I agree to be bound by the above Obligation of the United Brotherhood of Carpenters and Joiners of America, which I have read. I further agree that if it is found at any time that I have made false statements of any kind on this application that my membership shall be declared void and all monies paid by me shall be forfeited. Signature of Applicant Date (MM/DD/YYYY)

This application must be signed and dated by the applicant after being fully completed, then sent promptly to the General Office by the Financial Secretary.

For Office Use Only:

Initiation Date Initiation Fee Paid Tax Schedule UBC ID Date to Journeyman Supplemental Dues Yes No Authorized Collective Bargaining Yes No Prior Member Yes No If Yes Prior Local CLIC Donation Yes No

(Voluntary) Political Affiliation

PACIFIC NORTHWEST

REGIONAL COUNCIL OF CARPENTERS

AUTHORIZATION FOR BARGAINING

I hereby authorize the United Brotherhood of Carpenters and Joiners of America (hereinafter the "International") and/or its affiliated, Pacific Northwest Regional Council of Carpenters, to act as my collective bargaining agent for purposes of negotiating my wages, hours, terms and conditions of employment. This authorization applies to my present and to any future employer engaged in Carpentry work (including all Schedule "A" work classification of the Carpenter trade) to be performed within the territorial jurisdiction of the Pacific Northwest Regional Council of Carpenters. With respect to Carpentry work to be performed outside the territorial jurisdiction of the Pacific Northwest Regional Council of Carpenters, I authorize the International and/or its affiliated Regional Council having territorial jurisdiction over such area to act as my collective bargaining representative. This authorization can be disclosed to my Employer or to a third person for purposes of cross-checking against payroll records in order to verify the Union's majority status under Section 9 of the National Labor Relations Act. If the Union so desires it can submit this card to the National Labor Relations Board (NLRB) for the purpose of obtaining an NLRB certification election. This authorization shall remain in full force and effect until cancelled by written notice to the Union. Signature _ Date

Print Name _ SSN-

Address _ City _ Stete _ Zip.

Phone — Employer

Washington Interior Exterior Systems

LOCAL UNION 41

231 Burnett Avenue North, Suite B

Renton WA 98057

TODAYS DATE

NAME ADDRESS PHONE - MOBILE -

BIRTHDATE / / SEX: MALE FEMALE

CLASSIFICATION APPLYING FOR: JOURNEYMAN APPRENTICE UTILITY WORKER

HAVE YOU EVER HELD UNION MEMBERSHIP? YES/NO

IF YES, WHAT TRADE? GRADUATED TRADE SCHOOL/PRE-APPRENTICESHIP? YES/NO

IF YES, WHERE? MILITARY VETERAN? YES/NO

EMPLOYMENT HISTORY: PLEASE PROVIDE PAY STUBS AND/OR HOURS REPORT FROM WORKSOURCE.

COMPANY NAME AND CITY FROM: / TO: /

SUPERVISOR: PHONE: TYPE OF WORK: WAGE:

COMPANY NAME AND CITY FROM: / TO: /

SUPERVISOR: PHONE: TYPE OF WORK: WAGE:

COMPANY NAME AND CITY FROM: / TO: /

SUPERVISOR: PHONE: TYPE OF WORK: WAGE:

office use only REVIEWED BY: DATE: COMMENTS:

Pacific Northwest Regional Council of Carpenters

EIS READY-TO-WORK LIST QUESTIONNAIRE

For Exterior/Interior Systems (EIS) Carpenters

Interior Systems Central Dispatch: 1-800-***-**** or 253-***-**** Fax: 253-***-**** • Email: adz7qt@r.postjobfree.com Send to: Dispatch, PNWRCC, 25120 Pacific Hwy S, Ste 200, Kent, WA 98032 PLEASE PRINT LEGIBLY!

Check 4 here. I am:

[ ] Journeyman carpenter

[ ] Apprentice carpenter

Term

[ ] Utility Worker

Level

Name UBC ID# UBC Local #

Address Date of Birth

City State Zip Phone #

Email Phone #

Ethnicity (Optional): [ ] Asian [ ] Hispanic or Latino [ ] White [ ] Black or African American

[ ] Native American or Alaska Native [ ] Other

YOU ARE SKILLED/QUALIFIED TO ACCEPT WORK IN THESE SKILLS:

(Mark with a check 4 below.)

YOU ARE TRAINED IN THE FOLLOWING: (Mark with a check 4 below.) Check 4 here if you ONLY work in one of the following: [ ] Scaffolding ONLY (115) [ ] Residential ONLY (108) Check 4 the areas where you

are willing to work. Refer

to the enclosed area map.

(Please include area code.)

(Please include area code.)

[ ] Best Practices in Health (107)

[ ] Boom Truck Cert (164)

[ ] Certified Welder (113)

[ ] Cleanroom Class (176)

[ ] Door Hardware (129)

[ ] Firestop Class (102)

[ ] First Aid / CPR Cert (121)

[ ] Foreman A Class (139)

[ ] Forklift Industrial (122)

[ ] Forklift Rough Terrain (103)

[ ] Acoustical/Suspended Ceiling (230)

[ ] Carpet Floors (205)

[ ] Cleanroom (176)

[ ] Door Hardware (129)

[ ] Drywall/Sheetrock Hanger (204)

[ ] Drywall/Sheetrock Taper (209)

[ ] Hand Taper (316)

[ ] Hand Texture (318)

[ ] Foreman (114)

[ ] HAZMAT (100)

[ ] Light Gauge Weld (221)

[ ] OSHA 10 (208)

[ ] OSHA 16 (210)

[ ] OSHA 30 (212)

[ ] OSHA 7600 (321)

[ ] Powder Actuated Tool (325)

[ ] Rigging (123)

[ ] Scaffold Erector (110)

[ ] Scaffold User (124)

[ ] Insulation (202)

[ ] Laminate Wood Flooring (213)

[ ] Lather (217)

[ ] Layout from Prints (219)

[ ] Metal Stud Framing (206)

[ ] Residential (125)

[ ] Resilient Flooring(231)

[ ] Solid Wood Flooring (182)

[ ] Texture Spray (329)

[ ] Solid Surface Installer Class (182)

[ ] Steward (112)

[ ] Stick Cert Weld (156)

[ ] STP Cert (201)

[ ] TIG Cert Weld (155)

[ ] WABO Cert (192)

[ ] Wire Cert Weld (154)

[ ] Aerial Lift (260)

[ ] Fall Protection (265)

[ ] Tool/Mech Taper (331)

[ ] Total Station (133)

[ ] Transit Theodolite (224)

[ ] Welder (127)

[ ] Will work with Heights (116)

Are you a veteran? (800)

[ ] YES [ ] NO

[ ] Area 1 [ ] Area 13

[ ] Area 2 [ ] Area 14

[ ] Area 3 [ ] Area 15

[ ] Area 4 [ ] Area 16

[ ] Area 5 [ ] Area 17

[ ] Area 6 [ ] Area 18

[ ] Area 7 [ ] Area 19

[ ] Area 8 [ ] Area 20

[ ] Area 9 [ ] Area 21

[ ] Area 10 [ ] Area 22

[ ] Area 11 [ ] Area 23

[ ] Area 12

I (print name), assign to the Pacific Northwest Regional Council of Carpenters, from my earnings, a sum equal to the Union’s membership dues, assessments, and initiation fee (the Union will notify my Employer of the current amount). I authorize and direct my Employer to deduct such sum and remit the money to the Union monthly. This assignment is irrevocable for one (1) year from this date or until the termination of the Labor Agreement, whichever occurs first. This assignment shall be renewed automatically, for succes- sive 12 month periods, unless the Union and my employer receive my written notice of termination of this assignment not more than twenty (20) days and not less than ten (10) days prior to renewal of the assignment. This authorization is effective regardless of my status as a member, non-member, or

“financial core” payer and applies regardless of any future resignation of membership on my part. I authorize the PNWRCC to contact me at the sup- plied phone number(s) for the purpose of dispatching, reminders, or mobilization efforts. I hereby authorize the UNITED BROTHERHOOD OF CARPENTERS AND JOINERS OF AMERICA to act as my collective bargaining agent in dealing with my employer in regard to wages, hours, and other conditions of employment. All previous authorizations made by me are revoked. Signature Date

10.2013/sek/opeiu8alfcio

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11

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16

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15 18

14

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PACIFIC NORTHWEST

REGIONAL COUNCIL OF CARPENTERS

DISPATCH AREAS FOR CARPENTERS

& EXTERIOR INTERIOR SYSTEMS CARPENTERS

1 WWA NORTH 13 ID SOUTHEAST (IDSE)

2 WWA CENTRAL 14 ID SOUTHWEST (KDSW)

3 WWA SOUTH 15 MT NORTHWEST

4 WWA WEST 16 MT SOUTHWEST

5 SOUTHWEST WA 17 MT CENTRAL

6 OR NORTHWEST (ONW) 18 MT NORTHEAST

7 OR CENTRAL (OC) 19 MT SOUTHEAST

8 OR SOUTHWEST (OSW) 20 THE WHOLE STATE OF WYOMING 9 CENTRAL WA 21 AK NORTH

10 EASTERN WA 22 AK SOUTHWEST

11 OR NORTHEAST (ONE) 23 AK SOUTHEAST

12 OR SOUTHEAST (OSE)

REVISED 6/2011 / SEK / opeiu8aflcio

21

22

23

AREA 1

WWA - North

SKAGIT • SNOHOMISH

WHATCOM • ISLAND • SAN JUAN

AREA 2

WWA - Central

KING

AREA 3

WWA - South

PIERCE • THURSTON • LEWIS

AREA 4

WWA - West

CLALLUM • JEFFERSON • KITSAP

MASON • GRAYS HARBOR

PACIFIC (North)

AREA 5

SW WA

WAHKIAKUM • COWLITZ • CLARK

SKAMANIA • KLICKITAT

PACIFIC (South)

AREA 6

OR - NW

CLATSOP • COLUMBIA • TILLAMOOK

YAMHILL • WASHINGTON

CLACKAMAS • MULTNOMAH

AREA 7

OR - Central (OC)

POLK • MARION • LINCOLN

BENTON • LINN • LANE

AREA 8

OR - SW (OSW)

COOS • CURRY • DOUGLAS

JOSEPHINE • JACKSON • KLAMATH

AREA 9

Central WA

CHELAN • DOUGLAS • GRANT

KITTITAS • OKANOGAN • YAKIMA

AREA 10

Eastern WA - Northern ID (EWA)

ADAMS • ASOTIN • BENTON • FERRY

FRANKLIN • GARFIELD • LINCOLN

PEND ORIELLE • SPOKANE • STEVENS

WALLA WALLA • WHITMAN

BOUNDARY • BONNER • KOOTENAI

BENEWAH • SHOSHONE • LATAH • LEWIS

NEZ PERCE • CLEARWATER • IDAHO

AREA 11

OR - NE

HOOD RIVER • WASCO • SHERMAN

GILLIAM • WHEELER • MORROW • UMA-

TILLA GRANT • UNION • BAKER • WALLOWA

DESCHUTES • CROOK • JEFFERSON

AREA 12

OR - SE

HARNEY • MALHEUR • LAKE

AREA 13

ID - Southeast

CLARK • BUTTE • JEFFERSON • FREMONT

MADISON • TETON • BONNEVILLE • POWER

CASSIA • ONEIDA • BANNOCK • FRANKLIN

BEAR LAKE • CARIBOU • BINGHAM

AREA 19

MT - Southeast

MUSSELSHELL • YELLOWSTONE

BIG HORN • TREASURE • ROSEBUD

POWDER RIVER • CUSTER

CARTER • FALLON

AREA 20

STATE of WYOMING

AREA 21

AK - North

North Slope • Northwest Arctic • Yukon-Koyukuk

Fairbanks North Star • Southeast Fairbanks

Denali • Nome

AREA 22

AK - Southwest

Wade Hampton • Bethel • Dillingham

Lake and Peninsula • Matanuska-Susitna

Valdez-Cordova • Kenai Peninsula • Kodiak Island

Aluetians East • Aluetians West

AREA 23

AK - Southeast

Yakutat • Haines • Skagway-Hoonah-Angoon

Sitka • Juneau • Wrangell-Petersburg

Prince of Wales - Outer Ketchikan

Ketchikan Gateway

sek/9.2013/opeiu8aflcio

AREA 13

ID - Southeast

CLARK • BUTTE • JEFFERSON • FREMONT

MADISON • TETON • BONNEVILLE • POWER

CASSIA • ONEIDA • BANNOCK • FRANKLIN

BEAR LAKE • CARIBOU • BINGHAM

AREA 14

ID - Southwest

ADAMS • VALLEY • LEMHI • MINIDOKA • GEM

WASHINGTON • PAYETTE • BOISE • CUSTER • ADA

CANYON • ELMORE • OWYHEE • CAMAS • BLAINE

GOODING • LINCOLN • JEROME • TWIN FALLS

AREA 15

MT - Northwest

LINCOLN • SANDERS • MINERAL

MISSOULA • LAKE • FLATHEAD

POWELL • LEWIS AND CLARK

TETON • PONDERA • TOOLE • GLACIER

AREA 16

MT - Southwest

RAVALLI • GRANITE • BEAVERHEAD

DEER LODGE • SILVER BOW • MADISON

GALLATIN • JEFFERSON • BROADWATER

AREA 17

MT - Central

LIBERTY • CHOTEAU • HILL • BLAINE • CASCADE

JUDITH BASIN • FERGUS • MEAGHER

WHEATLAND • PARK • SWEETGRASS

GOLDEN VALLEY • STILLWATER • CARBON

AREA 18

MT - Northeast

PHILLIPS • VALLEY • GARFIELD

McCONE • PRAIRIE • WIBAUX

DAWSON • RICHLAND • ROOSEVELT

DANIELS • SHERIDAN • PETROLEUM

Pacific Northwest Regional Council of Carpenters

Affiliated with the United Brotherhood of Carpenters & Joiners of America 25120 Pacific Highway South • Suite 200

Kent, Washington 98032

253-***-**** • 253-***-**** fax • 1-800-***-**** toll free Dear Brother/Sister:

Welcome to the Pacific Northwest Regional Council of Carpenters. Your participation is valuable to this organization. We look forward to getting to know you. You agreed to attend the Pacific Northwest Regional Council of Carpenters’ New Member Orientation. The information provided at the orientation will benefit both you and your family. We encourage you to bring your spouse, partner, or family member. Attendance will waive your $300 initiation fee into your local union. The orientation should take approximately one hour, plus discussion. A light meal will be provided. Union Representatives will explain policies, discuss health and pension benefits, training opportunities, job search tactics and answer any questions you may have.

To ensure that your initiation fee is waived, be sure to arrive on time and sign out upon class completion. If you are unable to attend your scheduled orientation, please contact your local union immediately. (See local union phone number below.)

Fraternally,

Doug Tweedy

Executive Secretary-Treasurer/CEO

PNWRCC

DT/sek/opeiu8aflcio

LU complete:

Orientation Address

Date Time

Local Union Phone

Member complete:

UBC# U-__ __ __ __ - __ __ __ __

Name

Signature

Date

LU COMPLETE:

Orientation Address

Date Time

Local Union Phone

MEMBER COMPLETE:

UBC #: U -

Name

Signature

Date

Contact this candidate