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2. DISCLAIMER: By registering, you agree to have your information added to a list of skilled workers for City of Carbondale bid projects. The City of Carbondale makes no endorsement of your skill or qualification for employment. In no way does completing this form create an employer/employee relationship. The City of Carbondale does not have involvement with the selection of registrants from this form by contractors. The registry is not an exclusive list of available skilled labor workforce and does not create a duty of contractors to use as an exclusive hiring list.
4. Name (First, Middle Initial, Last)*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Date of Birth*
16. Race (select all that apply)*

    1. Black/African American
    2. Asian
    3. Hispanic/Latino
    4. Native Hawaiian/Pacific Islander
    5. White
    6. Native American
    7. Prefer not to say
17. Gender*

    1. Female
    2. Male
    3. Non-binary
    4. Other
    5. Prefer not to say
19. Disabled*

    1. Yes
    2. No
20. Veteran*

    1. Yes
    2. No
21. Union Member*

    1. Yes
    2. No
22. If yes, union name
24. Speciality (select all that apply)*

    1. Carpenter
    2. Electrician
    3. Glazier
    4. Insulator
    5. Ironworker

    1. Laborer
    2. Landscaping
    3. Mason
    4. Mechanic
    5. Operator

    1. Painter
    2. Pipefitter
    3. Plaster
    4. Plumber

    1. Roofer
    2. Sheet metal
    3. Teamster
    4. Tiler
26. Years of Experience*

    1. 0-5 yrs
    2. 6-10 yrs
    3. 11-15 yrs
    4. 16-20 yrs
    5. 20 yrs +
27. Please list projects in the Southern Illinois region where your skills were utilized

29. REFERENCES

31. Name*
32. Email*
34. Phone*
35. Number of years known*
37. Name*
38. Email*
40. Phone*
41. Number of years known*
43. Name
44. Email
46. Phone
47. Number of years known
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field