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LINEMAN (M/F) - CARLSBORG

Name: Date:

Email address:

Feel free to re-format this form to adequately respond to the questions.

EXPERIENCE AND KNOWLEDGE: Describe your experience and knowledge in the following areas:

A. Journeyman Lineman yes no # yrs

B. Lineman Apprentice Program (where)

C. IBEW Affiliated yes no # yrs

D. Trucks

1. Washington Commercial Driver's License with Class A

and air brake endorsement yes no # yrs

2. Driven pickup trucks, manual transmission yes no # yrs

3. Driven larger truck, such as flatbed yes no # yrs

4. Driven dual rear axle trucks yes no # yrs

5. Driven truck/trailer combination yes no # yrs

If yes, approximately how many times did you back up with trailer?

E. Equipment

1. Operated forklift yes no # yrs

2. Operated hydraulic derricks/booms yes no # yrs

3. Operated manlift booms yes no # yrs

Training:

A. High school diploma or equivalent: yes no

Name of High School:

B. College, University, or Technical School attended:

Years: Degree, certificate, classes taken:

C. Fundamental mathematics:

1. Education

2. Mathematics experience

D. Additional education and related courses helpful to this position:

OTHER:

Specify how you heard about this job opening:

c  Ad: Name of Newspaper

c  Website: URL

c  Referred by: Name

c  Other:

Signature Date

Lineman Carlsborg SQ 6/2017