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Portability Check-In Form
 IBEW Local 265 Portability

 
First name:
Last Name:
Email Address:
Phone:

  Please list the names, IBEW card number, and classification of those on portability.

  Enter 'NA' in the name field if less than four members. 

Local Number:
Member Name:    Card Number:    Classification: 
Member Name:    Card Number:    Classification: 
Member Name:    Card Number:    Classification: 
Member Name:    Card Number:    Classification: 

    A copy of each dues receipt must be submitted through: Email: info@ibew265.org, Fax @ 402-423-4506, or in person @ 1409 Old Farm Rd, Lincoln, NE

Employer:
Project:
Project Start Date:
Project End Date:

NECA Member?  Yes            No
Current EPR Live user?:  Yes            No

   Reporting in EPR Live: Everything is reported to Local 265 including H&W, Pension, Dues, JATC, LMCC, Vacation, and NEBF. (Benefits will go through the ERTs system for employees working on portability. They will need to be registered in ERTs before reporting to work in Local 265's jurisdiction to insure full benefit reciprocation.)

 Type of Work

 Commercial

 Industrial

 Telecommunication

 Residential

Submitting this form signifies that you have read and agree to work in compliance with the portability procedures of IBEW Local Union #265.

Signature:

Use your mouse, finger, or touch device to write your signature.


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IBEW Local 265
1409 Old Farm Road
Lincoln, NE 68512
  (402) 423-4497

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