Participating Employer Participating EmployerA Pederson's PlumbingA-1 PlumbingAdvantage Plumbing IncAlbin's PlumbingAlpine Plumbing and Mechanical LLCB.C. Plumbing, Inc.B&G Excavation & Plumbing LLCBathtub Solutions IncBeaver Plumbing & Heating IncBerry Plumbing, IncBethell Plumbing LLCBlakely PlumbingBlazer Industries IncBrass PlumbingBuckmaster Pro Plumbing & HeatingBudget Rooter of OregonCaliber Plumbing & Mechanical IncCamps Plumbing LLCCherry City Plumbing IncComplete PlumbingCorbett Mechanical IncDoneRite Plumbing LLCDSL BuildersEvenflo PlumbingEvergreen Plumbing & Mechanical LLCFair Share Construction LLCFriesen Plumbing IncG3 PlumbingGarcia Plumbing LLCGagles HeatingGLS PlumbingGemini CorpHammerquist IncHillside Plumbing, LLCGo Plumbing & Heating LLCHydro Temp Mechanical IncHR Mechanical Services LLCII-S Mechanical IncInnovative Plumbing and MechanicalISO Plumbing & MechanicalJack Wallace PlumbingJC Plumbing LLCJet Industries IncJims PlumbingJoling EnterprisesJohn's WaterproofingLamberts Plumbing SolutionsJudsons, IncLeftco IncLebanon Servco IncLifeworks PlumbingLincoln Plumbing IncLinn-Benton Plumbing LLCLovett, Inc.Lundell PlumbingMckillips Plumbing LLCMajors Plumbing IncMidway Plumbing IncMGR PlumbingModern Building SystemsMr. RooterNeu Flo PlumbingNewport PlumbingNoordam Plumbing IncNofco Plumbing LLCOn Track PlumbingOregon Cascade Plumbing & HeatingOregon Coast Pipe FittersOut West Plumbing IncPebbles Plumbing and MechanicalPipewerksPittman Plumbing & HeatingPKG ConstructionPlumbing 101 LLCPlumbers Northwest IncProline PlumbingPure PlumbingQuality West Plumbing LLC (Cascade Plumbing)R & R General Contractors IncRau Plumbing IncRidgeline PlumbingRG Smith Electrical Contracting IncRod's Plumbing, LLCRod Stutzman PlumbingRoth Heating & CoolingRon Knight PlumbingSlayden Constructors IncRoto-Rooter Service CompanySpaniols IncStutzman Services IncSuperior Plumbing of Oregon IncTerry Massey PlumbingThe Plumbers IncThomas Forbes Plumbing CoThrasher Plumbing LLCTIC Building LLCTip Top Plumbing, Inc.Town & Country Plumbing IncorporatedTwo Dogs Plumbing & DrainVicon Mechanical Contractor & PlumbingWolfers, Inc.None

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Is this an Applicant or an Apprentice? Is this an Applicant or an Apprentice? Applicant Apprentice

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Record of Activity Record of Activity I have interviewed this individual I have declined to interview this individual for the following reasons:

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Select all that apply Select all that apply Insufficient work experience (Out-of-Work Apprentices Only) Found Other Employment Did not want to work for our company Other, Please Explain:

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Acceptance of Conditions Acceptance of Conditions I understand that the Exit Survey and Release Form is to be submitted within 3 days of termination of employment. Companies remain financially responsible for all monthly billings up to and including the months between termination of employments and receipt of an exit survey by Area II Plumbers JATC.

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