IBEW Local 584

Portability Check-In Form

Local Union #584, IBEW

First Name

Last Name

SSN

Phone

Email Address

Member Local #

IBEW Card #

Mandatory Dues Receipt Submission

Send via Email - dispatch@ibew584.com
Send via Fax - 918-599-0584
Send via US Mail - 584 S Lewis Tulsa, OK 74104
Hand Deliver to Referral Office - 584 S Lewis Tulsa, OK 74104

Classification/Level

Employer

Project

Project Location

Client

Scope of Work

Start Date in Local 584

Anticipated Duration of Work

Type of Work

Inside Construction
Tele-data/VDV
Residential
Instrumentation

I understand that the work I will be performing...
within the jurisdiction of Local 584, IBEW is to be worked under the terms and conditions of the appropriate Collective Bargaining Agreement between Local 584, IBEW and the Eastern OK Chapter - NECA. I further understand that I am being allowed to work on the above listed project through the "Portability" section of said agreement and that, should said section be violated, I could be denied this right in the future. I further agree to notify Local 584 when my job assignment in this jurisdiction is complete. (The "Assignment Completion Form" is also available on this website.)

Signature

Date Signed

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