OPEU Local 459 Membership Form

MEMBERSHIP APPLICATION AND AUTHORIZATION FOR DEDUCTION OF DUES
I, the undersigned, hereby make application for admission to membership in the Office and Professional Employees International Union, AFL-CIO, Local 459 to serve as my chosen and authorized collective bargaining representative on matters relating to wages, benefits, hours, and other conditions of my employment.
Name *
Cell/Home Phone *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Apt#
Date of Birth *

Month Day Year
Date
Employer *
Dept./Unit
Job Title *
Date of Hire *

Month Day Year
Date
Employment Status *
If other, please type below
Hourly Wage
Home Email
example@example.com
Work Email
example@example.com
I authorize and direct my employer to deduct from my pay and to remit to OPEIU Local 459 membership dues in such sums as established by the Union Constitution and Bylaws. This authorization shall be irrevocable for one year after it is first executed or until termination of the Collective Bargaining Agreement between my employer and the Union, whichever occurs sooner. Revocation shall become effective when written notice is given by me to my employer and to the Union. I understand that my total dues deduction will automatically increase when my employment status and/or hourly rate increases, per the standard dues rates established by Local 459.
Signature *

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Date *

Month Day Year
Date
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