Local 223 Membership Application

Name *

First Name Middle Initial Last Name

SNN *

Address *

Street Address

Street Address Line 2

City State

Zip Code Country

Date of Birth *

Mobile Phone Number *

*By providing my cellphone number I understand that Teamsters may use automated text notifications, which I may opt out of at any time (message & data rates may apply).

Email *

example@example.com

Employer *

Location/Department

Job Title *

Hire Date *

Employee ID Number

If applicable

Full time or part time?

Full Time Part Time

Initiation Fee

Have you ever been a Teamster?

Yes No

If yes, which Local?

It's ok to use my name and image for Teamster publications

Yes No

Signature *

Clear

Date *

Date

I further understand that under current federal and state law I may elect nonmember status and may satisfy any obligation under a CBA to retain my employment by paying an amount equal to the uniform dues and initiation fees required of Union members. I understand that I may elect not to join or remain a Union member and may object to paying the pro-rata share of Union dues or fees not germane to collective bargaining, contract administration, and grievance adjustment and may request that the Union provide me with information concerning its most recent allocation of expenditures devoted to activities both germane and not germane to its performance as the collective bargaining agent so that I may decide whether or not to become an objector, and that non-members who choose to object to paying the pro-rata portion of regular Union dues or fees not germane to collective bargaining will be entitled to a reduction in fees based on the aforementioned allocation of expenditures as well as the right to challenge the propriety and accuracy of the allocation. Upon request the process for filing such a challenge will be provided by the Union. I have read and understood the options available to me.

TEAMSTERS LOCAL 223 DUES CHECKOFF AUTHORIZATION & ASSIGNMENT

I, the undersigned, hereby direct my employer to deduct from my earnings each month, regular amounts equal to the Union’s membership dues, initiation fee, if any, and uniform assessments and to transfer these deductions to Teamsters Local 223 monthly or more frequently if so provided in the collective bargaining agreement (CBA) between the Union and my employer. I understand that the Union may adjust the amount per the IBT Constitution and Local Union Bylaws. This authorization and assignment shall be irrevocable for a period of one year from the date of execution or until the termination date of the CBA, whichever occurs sooner. It shall remain in effect yearly thereafter and renew automatically unless I give written notice to both my employer and Local 223 during the 30 days prior to the expiration of the CBA or the anniversary date of my authorization. This authorization is voluntary and not conditioned on my present or future membership in the Union. Union dues are not tax deductible under current federal law.

- Required for automatic dues deduction from payroll -

Name

First Name Last Name

Signature

Clear

Date