liuna!€¦ · laborers' international union of north america liuna! feel the power to...

Laborers'

International

Union of

North America LiUNA!Feel the Power

TO REGISTER WITH THE LABORERS' UNION:

To register on the Registration List, the fee is $38.00 renewable monthly.

TO BECOME A MEMBER OF THE LABORERS' UNION:

The initiation fee into this union is $300.00, plus the monthly dues. Dues are presently $36.00per month and must be maintained thereafter. The total of $444.00 should be paid within yourfirst four months of work. Monthly dues are considered delinquent after 60 days. As an example,April dues must be paid by the end of May or you would be subject to suspension without notice.Our Agreements cover the State of Oregon only. If you work in another state and travel with acontractor, you will need to check into the local that has jurisdiction where you are traveling. Ifyou want to transfer to work in another state, you must have 6 months of good standing beforeyou can transfer locals.

HEALTH INSURANCE:

After a member has worked for a union contractor for 200 hours within a 3-month period theywill have medical, dental, vision and life insurance for oneself and their family. This coverageis paid for solely by your employer. Once your coverage has been activated, you will need 140hours per month working for the Union Contractor to keep it in effect. Should you run out ofcoverage, the Trust Office will send you a notice with several payment options for self-paymentsif you so choose. We recommend before going to a doctor that you check with the Trust Officeto be sure your coverage is in effect. The toll-free number for the Trust Office is1-877-396-5845. We also recommend that for specifics on the amount of coverage for any claim,you call the Trust Office.

PENSION PROGRAM:

Your Union employer will also be paying into a pension fund for you. Presently it takes 300

hours within a calendar year to earn a pension credit. Your pension is automatically vested afterearning 5 years of pension credits. You may have a break in the years you earn pension credits. Ifthe number of years in which you have credits is greater than you did not earn a credit, you willnot lose those pension credits. If the number of years in which you did not earn a credit is greaterthan the number of years in which you did, you will lose those previously earned credits. {Inother words, if you had 3 good years with credits and did not earn a creditfor 4 years you

would lose the 3 good credits years.) * NOTE! IF YOU WORK ON A PREVAILING

WAGE PROJECT THESE BENEFITS MAY VARY FROM JOB TO JOB. YOUR

UNION REPRESENTATIVE WILL EXPLAIN IN MORE DETAIL IF NEEDED.

Dispatch phone: (541) 801-2210 email: [email protected]

Office 541-801-2209 * 17230 NE Sacramento St., Suite 202 * Portland, Oregon 97230

www.Local737.org

OREGON LABORERS - EMPLOYERS TRUST FUNDSPO BOX 4148 - PORTLAND, OREGON 97208PHONE (503) 460-5245 - WATS (877) 396-5845

PLEASE PRINT

EMPLOYEE NAME: I I ILAST NAME. FinST NAME, MIDDLE INITIAL

SOCIAL SECURITY NUMBER:

MAILING ADDRESS;' I I

□ New TR 45 FOR OFFICE USE ONLYET

EFF

M □ F □ BIRTHDATE:

□ HOME PHONE

□ CELL PHONENUMBER:

EMAIL ADDRESS:

I STATE:

COUNTY:

ZIP CODE:

EMPLOYER: LOCAL NUMBER:

I AM SUBMITTING THIS: O TO UPDATE INFORMATION □ AS A NEW PARTICIPANT □ TO ADD FAMILY MEMBERS□ TO DELETE FAMILY MEMBERS, IF DELETION IS DUE TO DIVORCE GIVE DATE DIVORCE (DECREE) FINAL

DATE OF DIVORCE (DECREE)

CHOOSE ONE MEDICAL PLAN □ BLUE CROSS BLUE SHIELD □ KAISER HEALTH PLANCHOOSE ONE DENTAL PLAN: □ TRUST PUN (ACTIVE MEMBERS ONLY) □ WILUMETTE DENTACARE (ACTIVE OR RETIRED MEMBERS)ARE YOU MARRIED? □ YES □ NO IF YES, PLEASE GIVE DATE OF MARRIAGE:ARE YOU MARRIED?

DO YOU OR ANY FAMILY MEMBERS HAVE ANY OTHER GROUP COVERAGE? □ YES □ NO

CARRIER OR PLAN NAME

ARE YOU OR ANY OF YOUR FAMILY MEMBERS ELIGIBLE FOR MEDICARE?SELF MEDICARE ELIGIBLE; □ YES □ NO SPOUSE MEDICARE ELIGIBLE: □ YES □ NO CHILD/CHILDREN MEDICARE ELIGIBLE □ YES □ NO

To add a Domestic Partner - please contact the Administrative Office for the correct forms. Do not use this form to add a Domestic Partner.

SPOUSE NAME: I I I IUST NAME. FIRST NAME, MIDDLE INITIAL

SOCIAL SECURITY NUMBER; BIRTHDATE:

1. NAME: I I I I I ILAST NAME, FIRST NAME, MIDDLE INITIAL


2. NAME: 1 I I I I ILAST NAME, FIRST NAME, MIDDLE INITIAL


3. NAME: I I I I I ILAST NAME, FIRST NAME, MIDDLE INITIAL


4. NAME: I I I I I ILAST NAME. FIRST NAME, MIDDLE INITIAL


5. NAME: I I I I I 1LAST NAME, FIRST NAME, MIDDLE INITIAL


LIST ALL UNMARRIED ELIGIBLE CHILDREN

BIRTHDATE;

BIRTHDATE;

BIRTHDATE;

BIRTHDATE:

BIRTHDATE;

CHECK IF STEPCHILD: □

I I SEX: M □ F □


_J I SEX: M □ F □


-J I SEX: MD FD


_J I SEX: M □ F □


—I I SEX: M □ F □

LIFE INSURANCE BENEFICIARY INFORMATION1. PRIMARY BENEFICIARY:

RELATIONSHIP TO MEMBER:

2. CONTINGENT BENEFICIARY;

RELATIONSHIP TO MEMBER:

1 HEREBY APPLY FOR MYSELF AND FAMILY FOR THE BENEFITS ISSUED BY THIS TRUST AND ANY ENDORSEMENTS THERETO, ANDAGREE THAT THE SELECTION OF CARRIER IS BINDING UNLESS CHANGED IN WRITING ATTHE NEXT ENROLLMENT PERIOD.

5,000 6/17

SIGNATURE:

DUES CHECK-OFF ASSIGNMENT

Name Soc. Sec. No.

DUES DEDUCTION AUTHORIZATIONRecognizing that membership in the above Laborers Union is not a condition of job referral, I hereby votun-tanly authonze the above Employer or any Employer signatory to a Collective Bargaining Agreement withthe Oregon-Southem Idaho District Council of Laborers to deduct from my wages the hourly dues whichthe District Council has established and uniformity applied to all working members, and hereby direct theEmployer to remit such deductions to the Administrative Office in accordance with the terms of the applica-ble collective bargaining agreement or other agreement tor remittance which has t>een established betweenthe District Council and the Employer.This authonzation shall be irrevocable for a penod of one (1) year, or until the termination of the collectivebargaining agreement, whichever occurs sooner and shall be automatically renewed and shall be irrevocable for successive periods of one (1) each year, or for the penod of each succeeding applicable collectivebargaining agreement between my Employer and the Disthct Council, whichever shall be shorter, unlesswritten notice is given by me to my Employer, my Local Union and the District Council not more than twenty(20) days and not less than ten (10) days prior to the expiration of each period of one (1) year, or of eachapplicable collective bargaining agreement between my Employer and the Distnct Council whicheveroccurs sooner.

DATE SIGNATURE

LOCAL UNION #

AUTHORIZATION FOR REPRESENTATION

designate and authorize Oregon & Southern Idaho District Council ofLaborers affiliated with LABORERS' INTERNATIONAL UNION OF

NORTH AMERICA, AFL-CIO, to act as my coliective bargaining representative with my Empioyer.

This authorization is signed by me for the purpose of securing, for the Union, voluntaryrecognition and negotiation rights with my Employer and with any future employer.

Name (Please PRINT),

Street Address

City / State / Zip Code

Shift Worked (please check one):

Home Phone ( )

Signature

Day □ Afternoon □

Soc. Sec. #

Midnight □

Date(MUST BE SIGNED, NOT PRINTED)

THIS CARD IS CONFIDENTIAL AND DOES NOT REQUIRE ME TO JOIN OR PAY DUES.

TERRENCE M. O'SULLIVANGENERAL PRESIDENT

ARMANDE. SABITONiGENERAL SECRETARY-TREASURER

LRN/I HEADQUARTERS905 16TH STREET, NW

WASHINGTON, DC 20006-1765

APPLICATION FOR MEMBERSHIPDate

I do here by apply for membership in Local Union No. affiliated with the Laborers'International Union of North American and agree to abide by all the provisions of the Constitution andBy-Laws of said Local and the International Union.

Home Phone (Area Code & No.)

Signature (Do No Print) Cell Phone (Area Code & No.)

Print Your Name Email Address

Social Security No.

Address

Date of BirthMonth Day Year

No. Street Qty State Zip

Laborers'

International

Union of


INSTRUCTIONS ON HOW TO PAY UNION DUES

Please pay all dues and initiation payments online, you may go to

www.locaI737.org

Use the last four numbers of your social security as your member number, until youreceive your member card by mail. All dues are due the first day of each month, but youhave until the end of the month to make a payment.

You can sign up for recurring withdrawals from a credit or debit card by calling the officeat (541) 801-2209, to set up an automatic debit for the union dues payments. You areresponsible to pay your Union Dues each month, as they do not come out of yourpaycheck. We do not send out invoices.

Check Payments can also be mail to the following address:

Laborers' Local 737

17230 NE Sacramento St., Suite 202Portland, OR 97230

If you go 2 months without paying your dues you will then become suspended. And$25.00 service charge will be applied to the past due amount.

If you are unable to make any payments, please call the office to plan any arrangements.If we are able, we will work with all members on extending the initiation dues. Themonthly union dues cannot be extended and must be paid each month to remain an activemember status.


Office 541-801-2209 * 17230 NE Sacramento St., Suite 202 * Portland, Oregon 97230www.Local737.org

Laborers' International Union of North AmericaLocal No. 737

17230 NE Sacramento St., Suite 202Portland, OR 97230

(541) 801-2209 or (541) 801-2216Fax: (503)296-2510

To pay dues online go to www.laborerslocal737.oi ti

JOURNEYMAN INITIATION AGREEMENT

I, dispatched to ,Hereby acknowledge that I owe Laborers' Local Union No. 757 initiation fees of $300.00 and one month'sdues of $36.00. Below are the payment arrangements that I agree to. I will further realize that if these setpayments dates are not kept, that I will be subject to removal from the job of any signatory contractor withoutfurther notice.

Payments are as follows:

1®^ Month $65.00 Towards Initiation Fee & $36.00 Monthly Dues, Total of $101.00

2"'' Month $79.00 Towards Initiation Fee & $36.00 Monthly Dues, Total of $115.00

3"^ Month $78.00 Towards Initiation Fee & $36.00 Monthly Dues, Total of $114.00

4^*^ Month $78.00 Towards Initiation Fee & $36.00 Monthly Dues, Total of $114.00

After completion of this agreement, I understand that current monthly dues are $36.00, which are due on thefirst day of each month and the suspension from the Union will automatically occur on the sixty-first day of anonpayment.

I also understand that working dues, which appear on my dispatch, and check stub are not payment of thesemonthly dues.

I will immediately inform the Union hall of any change in the status of my employment, phone number, oraddress and I will abide by the hiring hall practices and procedures to remain as a member in good standingwith Union Hall. All correspondence with the Union Hall shall be made at the above address and checks shouldbe made payable to Laborers' Local 737.

I hereby acknowledge receiving a copy of this statement, with the original to remain in the office of the UnionHall.

Date Signed Membership Applicants Signature

Witness of Signature

Laborers'

International

Union of


Drug Testing Result Release

The undersigned member of Laborers' Union Local 737 hereby authorizes the release to an authorized official ofLaborers' Local 737 the results of any employment related drug test administered to me by said employer. This release islimited to either pass or no pass information for the limited purpose of determining eligibility for future dispatching.

Print Name Last 4 SSN / Member #

Signature Date

Hiring Hall Procedure Agreement

The Master Laborers Agreement, under which our members work, requires that we do our dispatching in accordance witha "Hiring Hall Procedure". When our office receives a call from a Union contractor for laborers, the Union shall referqualified Laborers to that employer in the following order of referral, we start telephoning those people who are qualifiedfor the job between the hours of 08:00 AM and 04:00 PM, beginning with our "A - Out of Work List". If we cannot fillthe job order from the "A List", we go to the "B - Out of Work List". The out of work lists are defined in Article 9 of ourMaster Labor Agreement.

If we cannot fill the job order from the "B List" we then go to the "C List". (This is usually at the peak of the constructionseason). Once a person registered on the "C List" is dispatched to a union job, he/she must join the Union. Anyone whoturns down or is unavailable for two (2) consecutive job referrals for such laborers is qualified shall be automatically reregistered at the bottom of the appropriate list. All members and non-members must renew his/her registration every thirty(30) days, or you will be removed from the list. Any member or non-member who signs a dispatch or takes a job referraland does not show up for work will be removed from the "Out of Work List" and must re-register on the bottom of the"Out of Work List".

We do not discriminate against any person with regards to; age, race, religion, color, sex, national origin nor ancestry.

If a member works less than five (5) days for an employer for which he/she was dispatched, he/she will be replaced on the"Out of Work List" in their past position; again, it is the member's responsibility to notify the Union of layoff ordismissal. If a member works more than five (5) days he/she must re-register at the bottom of the appropriate "Out ofWork List".

If you have further questions concerning our Hiring Hall Procedures or dispatching, please feel free to contact us at(541) 801-2209 or call one of our Field Representative closest to you.

All Hiring Hall Rules not listed here please refer to the Master Labor Agreement and Local Hiring Hall Rules.


Signature Date



www.Local737.org

® 130

Laborers'

International

Union of


LABORERS' CODE OF PERFORMANCE

The goal of the Code of Performance is to ensure that our membership meets the higheststandards in our industries. Our aim is to deliver craftsmanship that exceeds the expectations ofour contractors and their customers. We want to create and maintain a workforce that makes

contractors want to be Union and owners want to build Union

Meeting these goals requires that members understand and incorporate these values in their day-

to-day performance. Accordingly, a s a Union Laborer I agree to:

Acquire the necessary skills through apprenticeship and/or training programs.

Show up on time, ready willing and able to work

Give a fair day's work

o Adhere to collective bargaining agreement for start, quit and break times,

o Be drug fi-ee

o Be productive - minimize idle time

Treat the Employer's and the customer's tools and property with respect.

Avoid disruptions on the job by using the established procedures to resolve

disputes.

Understand and use safe practices and safety equipment.

I acknowledge this responsibility and pledge my word to do the same.


Signature Date



www.Local737.org

Laborers'

International

Union of

North America LiUNA!LOCAL

Feel the Power

Name Last4ofSSN

Address

City / State / Zip Code

E-mail

Cell Phone Number Home Phone Number

I authorize the Laborers Union to notify me via text message or by robo dial.(*Data/Message Rates May Apply)

Signature Date

Skills

Please indicate the skills, certifications and training you possess. Only check the box where you canskillfully perform the work, so that we can ensure successful, safe projects. If you would like training ina particular area, please contact the Local Union or visit the training school website at;

www.oregonlaborers.com.

[] ABATEMENT / REMEDIATION

[] Asbestos Worker[] Asbestos Supervisor

[] ASPHALT LABORER[] Asphalt Raker[] Asphalt Dump Man

[] BILINGUAL

Certification Exp. Date:Certification Exp. Date:

Laborers'

InteTTiatioTial

Union of

North America LiUNA!LOCAL737

BLUEPRINT / PLAN READING

BOOM LIFT / SCISSOR LIFT CERTIFICATION

CDL-A

CDL-B

CDL - Hazardous Materials Endorsement

CDL - Tank Endorsement

CHUCK TENDER

Chuck Tender - CasingChuck Tender - Rock

CONCRETE LABORER

Concrete - Chute Man

Concrete - Finisher

Concrete - Hose Man

Concrete - Hose Puller

Concrete - Vibrator

CONCRETE SPECIALIST

Concrete Specialist - Concrete GroutingConcrete Specialist - Concrete Nozzleman, Gunite and ShotcreteConcrete Specialist - Sack and Patch

Feel the Power

Certification Exp. Date:

Certification Exp. Date:Certification Exp. Date:Certification Exp. Date:Certification Exp. Date:

CONFINED SPACE CERTIFICATION

C STOP CERTIFICATION

DEMOLITION

Demolition Cutting Torch

DIRECTIONAL DRILL

DISASTER SITE WORKER

DISTRIBUTION SCALE

DRIVER'S LICENSE



FIRST AID/CPR Certification Exp. Date:

Laborers'

International

Union of

North America LiUNA!LOCAL737

Feel the Power

[] FLAGGING[] Flagger - Pilot Car[] Flagger - Traffic Control Supervisor (TCS)

[] FORMAN EXPERIENCE

Certifieation Exp. Date:

Certifieation Exp. Date:

Number of Years:


[] GENERAL LABORER(Includes but not limited to: Clean-Up, Carpenter Helper, Fire Watch,Fonn Setter, Fonn Stripper, Plumber Digger, Tool Room, Plant Safety)

[] GENERAL LABORER PIPELINER-Gas

[] GRADE CHECKER[] Grade Checker - GPS[] Grade Checker - Laser[] Grade Checker - Metrics

[] HAZARDOUS MATERIALS[] Hazardous Waste Worker[] Lead Abatement

[] HIGHSCALER

[] HOD CARRIER[] Hod Carrier - Brick / Block[] Hod Carrier - Monocoat Pump[] Hod Carrier - Plaster[] Hod Carrier - Refractory

[] ICRA HOSPITAL RENOVATION

[] MSHA - Miner Safety Training

[] OSHA 10[] OSHA 30

[] PIPELAYER[] Pipelayer - GPS Level[] Pipelayer - Gravity[] Pipelayer - Poly Fusion Pipe[] Pipelayer - Pressure[] Pipelayer - Top Hand



Issued Date:

Issued Date:

Laborers'

InternatioTial

Union of


Feel the Power

Pipeline Operator Qualification (OQ)

Pipeline Safety Certification

POWDERMAN CERTIFICATION

POWER SAW OPERATOR

POWER TOOLS OPERATOR

Jackhammer

Jumping Jack

RAILROAD LABORER

RESPIRATORY PROTECTION COURSE

RIGGING & SIGNALING CERTIFICATION

Rigging & Signaling / Bellman

SAWCUTTING

Sawcutting - Core DrillSawcutting - Floor / Wall SawSawcutting - Target Saw OperatorSawcutting - Wire Saw

SCAFFOLD USER

Scaffold Builder (80 Hours)Scaffold Erector (40 Hours)

SHIPYARD

SMALL EQUIPMENT

OPERATOR CERTIFICATION

Air Track Drill OperatorBobcat

Forklift License

Power Buggy




Completed Date:


Certification Exp. Date:Certification Exp. Date:



TIMBER FALLER

TUNNEL MINER

Laborers'

International

Union of


[] TWICCARD

[] WELDER[] Welder-Thermite

SHIFTS

[] Days[] Graveyard[] Swing

ETHNICITY AND GENDER IDENTIFICATION

(Voluntary: Assists with certain governmental job goals / requests)

[] African American[] Asian / Pacific Islander[] Caucasian[] Hispanic[] Minority[] Native American[] T.E.R.O[] Other

C

[] Female[] Male

REGIONS:

Please indicate which regions, designated by Counties, you are willing to travel to.(See attached map for additional assistance)

1 - Clatsop, Columbia, Tillamook2 - Clackamas, Multnomah, Washington3 - Marion, Polk, Yamhill4 - Benton, Lane, Lincoln, Linn

5 - Coos, Curry, Douglas, Jackson, Josephine6 - Hood River, Sherman Wasco7 - Crook, Deschutes, Jefferson

8 - Klamath, Lake9 - Baker, Gilliam, Grant, Morrow, Umatilla, Union, Wallowa, Wheeler10 - Hamey, Malheur

Feel the Power

ertification Exp. Date:

OREGON

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Coumtna

Umatia

Watciwe

TilBmook

Washingtcn

Momcrw

Uncn

GBbm

Sharma

Yamhiu

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Marion

Wheeler

Lincoln

(^nt

Deschutes

Dowlas

Hamey

Malhejr

Klamath

Cuny

Jose

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Laborers'

International

Union of


When you are dispatched to work, you need to be ready to do your job. This includes being ableto be on time with proper tools and clothes.

Required Items

• Work Gloves

• 25' / 30' Metal Tape Measure

• 20 oz. Hammer

• Lineman Pliers

• Hard Hat

• Proper Footwear - Stout work boots, rubber boots if dispatched to concrete iobs{Sneakers or Casual Shoes are not allowed)

• Work Clothing fit for heavy work and appropriate for the weather {No Sweat Pants)

Recommended Items

o Utility Knifeo Small Cats Paw (Crowbar)o Crescent Wrench

o Utility Belto Extra Work Clothes {In case you need a change ofclothing)o Rain Gear

o Reliable Transportation to and from worko Asbestos Certification must be presented to employer upon dispatcho Proper Identification {Needed by Employer)

Two PoiTns of Identification:

Driver's License

Passport or State Identification CardSocial Security Card

If you should have any questions, please do not hesitate to give us a call at (541) 801-2210

Sincerely,

DispatcherOregon Laborers' Local 737



www.Local737.org

liuna!€¦ · laborers' international union of north america liuna! feel the power to...

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