663app

Laborers' Local 663 Application For Referral

When filling out this application, it must be pointed out this is for referral to jobs only. The applicant's qualification to perform classified work rests entirely with the employer.

Name*

First Name

Middle Initial

Last Name

Address*

City*

State*

Zip*

Home Phone

(###) ###-####

Cell Phone*

(###) ###-####

May We Contact you by Text

Yes No

SSN*

No Dashes

Email*

Confirm Email*

Date of Birth*

Gender

Married?

Yes No

Are You a US Citizen?

Yes No

Ethnicity / Race

Employment History - List all construction/environmental employers for the previous 4 years. Begin with the most recent. Include all employers union and non-union.

Select How much Experience you have working in the trade ( Union and Non-Union)

More than 4 years Between 2 and 4 years Less than 2 years

Past Employment

1. Most Recent Employment - Include Employer, Job location, Dates Employed, & Phone

2. Include Employer, Job location, Dates Employed, & Phone

3. Include Employer, Job location, Dates Employed, & Phone

4. Include Employer, Job location, Dates Employed, & Phone

Skills and Certifications - Please select all Skills you are cabable of and or have performed in the past and for wich you would like to be coinsidered for work. Select all CERTIFICATIONS you have licenses for and when they expire.

Skills

Asphalt

Mill Raker Screed Shoveler

Concrete

Grade Checker

GPS Laser Beam String Line Total Station

Pipe Layer

Gas Pipe With Laser Sanitary Sewer Water

Pipeline

CDL Type

Class A Class B Class C

Select all Areas you are willing accept construction work.

Zone 1 - Kansas City Zone 2 - Springfield Zone 3 - Joplin

How did you Hear About Us?

Please tell us : Online, DEROC, Another Union, Friend, etc.

Certification of this Application

I CERTIFY THAT ALL OF THE INFORMATION SUBMITTED BY ME ON THIS FORM IS ACCURATE AND COMPLETE, AND I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO UPDATE AND OTHERWISE KEEP CURRENT THE INFORMATION ON THIS FORM. I ALSO CERTIFY THAT I AM CURRENTLY PHYSICALLY ABLE TO PERFORM THE TASK OF THE SKILLS I HAVE SELECTED ABOVE.