Membership Form - Sylvia Escobar

MEMBERSHIP AND DUES DEDUCTION

Application Form

I voluntarily submit this Application for Membership in Local Union 848, affiliated with the International Brotherhood of Teamsters, so that I may fully participate in the activities of the Union. I understand that by becoming and remaining a member of the Union, I will be entitled to attend membership meetings, participate in the development of contract proposals for collective bargaining, vote to ratify or reject collective bargaining agreements, run for Union office or support candidates of my choice, receive Union publications and take advantage of programs available only to Union members. I understand that only as a member of the Union will I be able to determine the course the Union takes to represent me in negotiations to improve my wages, fringe benefits and working conditions. And, I understand that the Union's strength and ability to represent my interests depends upon my exercising my right, as guaranteed by federal law, to join the Union and engage in collective activities with my fellow workers.

I understand that under the current law, I may elect non-member status, and satisfy my contractual obligation necessary to retain my employment by paying an amount equal to the uniform dues and initiation fee required of members of the union. I also understand that if I elect not to become a member or remain a member, I may object to paying the pro rata portion of the regular union dues or fees that are not germane to collective bargaining, contract administration and grievance adjustment, and I can request the local union to provide me with information concerning its most recent allocation of expenditures devoted to the activities that are both germane and non-germane to its performance as the collective bargaining representative sufficient to enable me to decide whether or not to become an objector. I understand that non-members who choose to object to paying the pro rat a portion of the regular union dues or fees that are not germane to the collective bargaining will be entitled to a reduction in fees based on the aforementioned allocation of expenditures and will have the right to challenge the correctness of the allocation. The procedures for filing such challenges will be provided by the Union upon receipt of my objection. To become a non-member and/or object to the allocation, I must send my notification to the Executive Board at the Local Union Hall.

I have read and understand the options available to me and submit this application to be admitted as a member of the Local Union.

First Name

Middle Initial

Last Name

Are you Male or Female?

Male

Female

Address

Home Address

City

State

Zip Code

Social Security Number

Email Address

Phone/Mobile

Birth Date

Hire Date

Employee ID Number

Employer

Division

Hourly Wage Rate

Job Title

Have you ever been a member of the Teamsters?

Yes

If yes, with which Local Union?

Life With Dues (Death Benefit)

In the event of your death as an active member, the person(s) listed below will receive a death benefit of $4,000. The benefit will be split amongst the multiple beneficiaries evenly.

Beneficiary (Full Name)

Beneficiary (Relationship)

If beneficiary is 'Other', add relationship here:

Authorize Agreement

Agree

BY SIGNING THIS DOCUMENT ELECTRONICALLY, I CONSENT TO ENTER INTO THIS AGREEMENT FOR AUTHORIZATION OF DUES DEDUCTION WITH THE LOCAL UNION. I HAVE READ, UNDERSTAND, AND SUBMIT THIS APPLICATION TO BE ADMITTED AS A MEMBER OF THE LOCAL UNION.

Authorization For Payroll Deduction

I hereby authorize my employer to deduct from my wages each and every month an amount equal to the monthly dues, Initiation fees and uniform assessments to Local Union 848, and direct such amounts so deducted to be turned over each month to the Security-Treasurer of such Local Union for and on my behalf.

This authorization is voluntary and is not conditioned on my present or future membership in the Union. This authorization and assignment shall be irrevocable for the term of the applicable contract between the union and the employer or for one year, whichever is the lesser, and shall automatically renew itself for successive yearly or applicable contract periods thereafter, whichever is lesser, unless I give written notice to the company and the union at least sixty (60) days, but not more than seventy-five (75) days before any periodic renewal date of this authorization and assignment of my desire to revoke same.

Full Name

Employer

Signature

Sign Here

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