For Membership in Local Union No
I voluntarily Submit this application for membership in Local Union
Last Name
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First Name and Middle Initial
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Occupation
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Street
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City
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State
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Zip
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Employer
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Employment Date
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Employer Phone
Employer Street Address
City
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Initiation Fee
Paid To
Date of Birth
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Social Security Number
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Have you ever been a member of a Teamsters Local Union?
If yes, What Local Union No.
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Signature of Applicant
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I ___________ hereby authorize my employer to deduct from my wages
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Print Name
Local Union
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Signature
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Social Security Number
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Date
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Address
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State
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Employer
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