IATSE 122 OSHA 10 Application

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Due to the Funding of this class we are required to verify that the individual applicant works under IATSE Local 122 Collective Bargaining Agreement or is a beneficiary of the IATSE TTF. Fill out the below application and when verified you will receive sign up links for the first class that starts at least two business days after you are verified.

Email *

Full Legal Last Name (this is how it will appear on your card) *

Full Legal First Name (this is how it will appear on your card) *

Phone Number (10 digits) *

Date of Birth mm/dd/yyyy (required for international reimbursement) *

Street Address (where you want your card Mailed) *

City (where you want your card Mailed) *

Zip Code (where you want your card Mailed) *

State abbreviation (where you want your card Mailed) *

Have you been dispatched by Local 122 Referral Hall or worked at a venue under a local 122 collective bargaining agreement in the last year? *

Yes

Please provide the date you were first dispatched to a job with local 122 (mm/dd/yyyy) If you are a TTF beneficiary from another local please input TTF. *

Are you a member of Local 122? *

Yes

Are you a beneficiary of the IATSE TTF *

Yes

I certify that all the information in this form is true and complete to the best of my knowledge. I allow IATSE Local 122 Education program will share information from this form with with IATSE TTF and UCSD OSHA Training Institute.

Required

A copy of your responses will be emailed to the address you provided.

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