Name: Name:
Date: Date:
Phone Number: Phone Number
Email Address: Email Address
Local Number: Local Number:
How long have you been boilermaking?: How long have you been boilermaking?:
Have you ever worked in a refinery?: Have you ever worked in a refinery?YesNo
Have you ever worked in a tray tower?: Have you ever worked in a tray tower?YesNo
Do you have a TWIC card?: Do you have a TWIC card?YesNo
Do you have an OSHA 10 Hour card?: Do you have an OSHA 10 Hour card?YesNo
If so, was it issued within the last three years?: If so, was it issued within the last three years?YesNo
Do you have current and up to date RSO Training?: Do you have current and up to date RSO Training?YesNo
Are you a welder?: Are you a welder?YesNo
If so, what type of welder?: If so, what type of welder?PlateTubeCSSS
Who referred you to MIST Inc.?: Who referred you to MIST Inc.?:
Are you a Graduated Apprentice?: Are you a Graduated Apprentice?YesNo
Are you a Current Apprentice?: Are you a Current Apprentice?YesNo
*Our Out of Work list is not used in the order received.
