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
Phone
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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
State
Zip Code
Initiation Fee
Paid To
Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number
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Have you ever been a member of a Teamsters Local Union?
If yes, What Local Union No.
Date of Application
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
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City
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State
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Zip Code
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Employer
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