General Info
Name
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If yes, which one?
These questions are asked solely for the purpose of meeting federal record keeping required affirmative action. This hiring hall is administered without regard to race, color, religion, sex, marital status, sexual orientation, national origin, disability, age, or Veteran status, and In accordance with all Federal, State and local laws.
EEOC Classification
Military Branch
Dates Served
Which Tribe
Political Party
County
Voting District
Check the Zone or Zones that you are available to work in (Check all that apply):
Tulsa, Creek, Okmulgee, Washington, Nowata, Rogers Wagoner, Muskogee, Craig, Mayes, Ottawa, Delaware, Cherokee, Adair
Kay, Osage, Pawnee, Payne, Noble, Grant, Garfield, Alfalfa, Major
Oklahoma, Logan, Kingfisher, Blaine, Canadian, Cleveland, Pottawatomie, Lincoln, Okfuskee, Seminole, Hughes, Pontotoc
Comanche, Caddo, Kiowa, Tillman, Greer, Jasckson, Harmon, Grady, Stephens, Cotton, Jefferson, McClain, Garvin, Murray, Carter, Love
Harper, Woods, Ellis, Woodward, Dewey, Roger Mills, Custer, Beckham, Washita, Cimarron, Texas, Beaver
McIntosh, Haskell, Pittsburgh, Latimer, Coal, Johnston, Atoka, Marshal, Bryan, Choctaw, Pushmataha, McCurtain, Leflore, Sequoyah
Work History List only construction, environmental & industrial employers. Also, list job location, phone numbers and dates of employment for the previous two year. Begin with the most recent.
Employer 1
Job Location
Start Date
End Date
Phone Number
Employer 2
Job Location
Start Date
End Date
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Employer 3
Job Location
Start Date
End Date
Phone Number
Qualifications Place an "X" in the square of the skills that you are qualified to perform or have previously performed.
The following skills require current certification or license.
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I Apply
I do hereby apply for membership into Local Union #107 affiliated with the Laborers' International Union of North America, AFL-CIO and agree to abide by all the provisions of the Constitution and By-laws of said Local. I certify that all of the information submitted by me on this form is true and accurate to the best of my knowledge. I also understand that, it is my responsibility to update any current or relevant information on this form.
By providing your email and phone, you confirm your consent to receive messages from LiUNA & its affiliates, including any autodialed call, text
message or email, about important matters, including your contract, benefits, union operations, political, and legislative matter. You can opt-out at
any time.
Signature
Date
DUES CHECKOFF AUTHORIZATION AND ASSIGNMENT
I do hereby assign to the Southwest Laborers’ District Council, and affiliated LIUNA Local Union 107, (affiliates of the Laborers'
International Union of North America), and any successors, such amounts from my wages as shall be required to pay an amount
equivalent to the initiation fees, readmission fees, and membership dues of the local union, as may be established for its members from
time to time. My Employer, including my present Employer and any future Employer, is hereby authorized to deduct amounts from my wages and pay the same to the local union and/or its authorized representative, in accordance with the collective bargaining agreement in existence between the Union and my Employer.
This authorization shall become operative upon the effective date of each collective bargaining agreement between my Employer and the Union.
This authorization shall be irrevocable for a period of one (1) year, or until termination of the collective bargaining agreement in existence between my Employer and the Union, whichever occurs sooner; and I agree and direct that this authorization shall be automatically renewed and shall be irrevocable for successive periods of one (1) year each, or for the period of any subsequent agreement between my Employer and the Union, whichever shall be shorter, unless written notice is given by me to my Employer and the local union not more than 20 days and not less than 10 days prior to the expiration of each period of one (1) year, or of each applicable collective bargaining agreement between my Employer and the Union, whichever occurs sooner. For the effective period of this checkoff authorization and assignment, and to the extent permitted by law, furthermore, this checkoff authorization shall continue in accordance with the above renewal and revocation provisions irrespective of my membership in the Union.
Union dues and fees are not deductible as charitable contributions for federal income tax purposes. Local dues may qualify as business expenses, however, and may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue
Signature
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Send Application