UFCW 3000 Membership Application - Central WA Hospital

UFCW 3000 Membership Application - Central Washington Hospital
{signature} By selecting the "Check Box" and signing your name in the signature box(s), you are signing this Agreement electronically. You agree and consent to using your electronic signature for this application document and that it is the legal equivalent of your handwritten signature. You further agree that your signature on this application document is as valid as if you signed the document in writing. You are also confirming that you are the person authorized to make this application and that it is your intent to do so through electronic signature. Your consent and confirmation of your intent to be bound by this electronic signature only applies to this application document. You may request a hard copy of your signed application for your records. You can opt-out of signing this application electronically by notifying Local 3000 that you wish to sign the application in writing via ink (hard copy).
Name*

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Date of birth*

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Address*

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Phone Number*

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Employer*
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Start Date

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UFCW 3000 Membership Application*

I hereby make application for membership in the United Food and Commercial Workers International Union and affirm that the above statements are true and I agree that all monies paid by me shall be forfeited and my membership declared void if they are not true. I authorize the UFCW International Union to represent me for the purposes of collective bargaining and handling of grievances, either directly or through such local union as it may duly designate.
Signature*

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Today's date*

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ASSIGNMENT OF WAGES TO PAY UNION DUES*

I authorize any company I work for who has a contract with UFCW Local Union No. 3000 to deduct from my wages an amount equivalent to dues, initiation fees and assessments as certified by the Secretary-Treasurer of my Local Union and to pay that amount to my Union. I make this authorization in consideration for the cost of representation, collective bargaining and other activities my Union undertakes for me. This authorization is not contingent on my continued membership in the Union. This authorization shall be irrevocable for a period of one year from the date of execution thereof or until the termination of the collective bargaining agreement between the company I work for and my Union, whichever occurs sooner. This authorization will remain in effect from year to year thereafter, unless I give the company and my Union written notice of revocation bearing my signature thereon on any subsequent yearly period or when the collective bargaining agreement covering my employment expires and until a new collective bargaining agreement covering my employment becomes effective. My UFCW Local Union is authorized to deposit this authorization with any company under contract with my Union, including any company under contract with my Union that hires or rehires me in the future.
Signature*

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Today's date*

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VOLUNTARY POLITICAL CONTRIBUTIONS

CONTRIBUTING EVEN A SMALL AMOUNT HELPS US MAKE A DIFFERENCE TOGETHER. THESE DONATIONS HAVE HELPED US PASS PAID SICK LEAVE, RAISE THE MINIMUM WAGE AND PASS PRO-WORKER LEGISLATION THAT HELPS ALL WORKPLACES AS WELL AS OPPOSE ANTI-WORKER LEGISLATION.
VOLUNTARY POLITICAL CONTRIBUTIONS AUTHORIZATION

I understand that authorization is voluntarily made, that the amounts listed above are only guidelines, and that the making of payments to the UFCW Active Ballot Club is not a condition of membership in the Union or employment with the Employer and that I have a right to refuse to sign this authorization and not to contribute to the UFCW International Union/UFCW 3000 Active Ballot Club or to contribute more or less than the amounts listed without reprisal. Federal law prohibits UFCW ABC from soliciting contributions from individuals who are not UFCW members, executive and administrative staff or their families who are U.S. citizens or permanent residents. Any contribution received from such an individual will be returned to that contributor. The Union undertakes to indemnify and hold the Employer harmless from all claims, demands, suits or other forms of liability that may arise against the Employer for or on account of any deduction made from the wages of such employee. I understand that my contribution will be used for political purposes, including the support of candidates for federal, state, and local offices. This authorization form remains in effect until revoked in writing by the employee. Contributions or gifts to the UFCW International Union/UFCW 3000 Active Ballot Club are not deductible as a charitable contribution for federal tax purposes.
Per week contribution

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UFCW 3000 Membership Application - Central Washington Hospital

VOLUNTARY POLITICAL CONTRIBUTIONS