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Union Authorization Form
Are you a Agricultural Cannabis Workers or Public District Hospital Worker?
YES
NO
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Agricultural Cannabis Workers or Public District Hospital Worker
Union Authorization Request Form
Name
*
First Name
Last Name
Email
*
example@example.com
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Union Authorization Form
I authorize UFCW Local 3000 to represent me for the purpose of collective bargaining. This authorization may be used to obtain a secret ballot election or to gain recognition as my bargaining representative without an election.
Name
*
First Name
Last Name
Personal Email
*
example@example.com
Personal Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
*
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Job Title
Shift
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Will you help build power in your workplace by contacting coworkers, attending meetings, or participating in collective action?
YES!
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