FLLA Membership Application

Membership Application

MEMBERSHIP APPLICATION AND AUTHORIZATION FOR DUES DEDUCTION For Membership in Front Line Labor Alliance, Ltd. (Chapter 10, CCDOC)
I, First Name* Last Name* hereby voluntarily request and accept membership into the Front Line Labor Alliance, Ltd. and Front Line Labor Alliance, Chapter 10 (hereinafter, “Union”) and authorize my employer to deduct the correct amount of dues (1.5 times my hourly rate) and initiation fees (initiation fees are $0 on applying for membership following certification of the Union as the bargaining representative) from my paycheck and remit payment to the Union. I authorize the Union to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my employer. 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 Chapter office, and receive publications from the Union. I understand that only as a Union member will I be able to determine the course that the Union takes to represent me in negotiations to improve my wages, hours, working conditions, and other terms and conditions of employment. I have read and understand the options available to me and freely and voluntarily submit this application to be admitted as a member of the Union. Date*
Signature *

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Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birthdate

Month Day Year
Date
Employer *
Job Title
Hire Date

Month Day Year
Date
E-mail *
Phone Number *

Area Code Phone Number
I, First Name Last Name hereby freely and voluntarily authorize my employer to deduct from my wages each and every month an amount equal to the monthly Union dues (1.5 times my hourly rate) and initiation fees (initiation fees are $0 on applying for membership following certification of the Union as the bargaining representative), consistent with the FLLA, Ltd.’s By-laws, and direct such amounts so deducted to be turned over each month to the Secretary-Treasurer of FLLA, Ltd. for and on my behalf. This authorization is voluntary and is not conditioned on my present or future membership in the Union. This authorization shall renew automatically every year, unless I give written notice to the employer 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 and my desire to revoke the same. Date
Signature

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I First Name Last Name CONSENT TO RECEIVE ELECTRONIC COMMUNICATIONS
I agree that the Front Line Labor Alliance, Ltd. (“FLLA”) may send me electronic communications including text messages, phone calls, e-mails and autodialers with various contents. While FLLA will not charge me to utilize this service, I understand that standard text message rates and data charges from my carrier may apply Date
Signature

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