Membership Application Form

APPLICATION AND NOTICE

FOR MEMBERSHIP IN LOCAL UNION NO. 222 AFFILIATED WITH THE INTERNATIONAL BROTHERHOOD OF TEAMSTERS
I voluntarily submit this Application for Membership in Local Union 222, 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 "nonmember" status, and can satisfy any 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 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 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 nonmembers who choose to object to paying the pro-rata portion of regular Union dues or fees that are not germane to 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 my Local Union, upon request.

Name*

(FIRST NAME)(MIDDLE INITIAL)(LAST NAME)
Social Security No*
Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer*
ABF Worksite*
ALSCO Worksite*
Bimbo Bakeries Worksite*
Dean Dairy's Worksite*
Geneva Rock Worksite*
Are you full time or part time?*
Employee ID*
UPS Worksite*
YRC Worksite*
Seniority Date*

MonthDayYear
Date
Job Classification*
Rate of Pay*
Date Of Birth*

MonthDayYear
Date
Gender*
Email*
example@example.com
Have you ever been a member of a Teamster Local Union?*
If yes, what Local Union No.
DATE OF APPLICATION*

MonthDayYear
Date
Signature*

Clear
My Beneficiary Is*
Relationship*
Referred by Whom

CHECKOFF AUTHORIZATION AND AGREEMENT
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 of Local Union 222, and direct such amounts so deducted to be turned over each month to the Secretary-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.

Name*

First NameLast Name
Signature*

Clear
Social Security Number*
Date*

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState

Zip Code
Employer*
Please verify that you are human*
Should be Empty:

APPLICATION AND NOTICE

CHECKOFF AUTHORIZATION AND AGREEMENT