Storm Worker Registration Form

If you wish to be added to the list of Maverick Storm Workers deployed in the event of a storm or other natural disaster, please fill out the below form with all of your details.

Basic Information

Telephone:

Email:

Last Name:

First Name:

Street Address:

City:

Zip Code:

State:

License and Vehicle Information

Do you have an active drivers license?YesNo

License Number:

License State:

Do you have access to your own vehicle?YesNo

License Plate Number:

Other Information

Have you ever been convicted of a felony?YesNo

Classifications and More

Please select the position(s) that you want to work during a storm.

Secondary line worker classification:Journeyman LinemanEquipment OperatorGroundmanApprenticeForemanGeneral ForemanLine SupervisorNot Applicable

Damage assessor worker classification:Lead AssessorDriver/Jr. AssessorNot Applicable

Current Safety Certifications:CPRFirst AidOSHA 30OSHA 10

Wire Guard:Wire Guard

1-617-446-7037

sales@maverickcorporation.com