Evaluation

IUOE LOCAL 406 EVAL SHEET

Name(Required)

First Last

Date of Birth(Required)

Required Documents

Valid Driver's License(Required)

Valid TWIC Card(Required)

Valid Safety Card(Required)

CCO Certification Number(Required)

Crane Experience Verification(Required)

Can you verify 2000 hours of documented crane related experience? **If NO, please complete an apprenticeship application at www.iuoelocal406.org. If YES, complete the information below.

Work Experience(Required)

Employer

Address

Equipment Make

Equipment Model

Start Date

End Date

Operating Hours

Additional Crane Experience(Required)

Equipment Make

Equipment Model

Hours as Operator

References(Required)

Name

Title

Employer

Phone or Email

Technical Skills

Please answer "Yes" or "No" if you can complete the below skills.

Assembly and disassembly of equipment?(Required)

Reeving blocks and balls?(Required)

Pre-and-post operation inspections?(Required)

Installing and removing jibs?(Required)

Programming crane computers?(Required)

Extending/retracting outriggers?(Required)

Telescoping booms properly?(Required)

Cancellation Policy(Required)

Do you understand there is a $300 cancellation fee if you schedule an evaluation and do not show up without notice? Please answer yes or no.

Contact Information

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Last 4 digits of SSN(Required)

Emergency Contact(Required)

Name

Cell Phone

Other