Submit to the hall before 3:00 p.m. to go on the recorder the same day. Thank you.

Contractor*
Requestor*
Phone*
Job Name*
Job Address*
Street Address City ZIP Code
Other Job Info (be specific)
Number of JW*
Long/Short Call*
Rate*
Minnesota Electrical License Required*
- Yes
- No
Job Conditions*
- Indoor
- Outdoor
- Industrial
- Commercial
- Residential
- Service Work
Other Job Conditions
Report To*
Location (address of where they are to report to)*
Street Address City ZIP Code
Whom*
Start Date*
MM
DD
YYYY
Start Time*

: HH

MM
Location Phone*
Please use a phone number for someone that will be on the job site the day they start. Thank you.
Job Hours*
Do you need separation notices*
Where would you like them sent?
How do you want to receive the referrals?*
If you want referrals emailed we'll block out Social security number.
Fax number to fax referrals.*
E-Mail address to send referrals.*
Email address of person requesting manpower.*
Email
This field is for validation purposes and should be left unchanged.