APPLICATION FOR MEMBERSHIP

CHCA District 1199, NUHHCE, AFSCME, AFL-CIO

2 N Plains Industrial Rd. Wallingford, CT 06492
APPLICATION FOR MEMBERSHIP
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I hereby apply for membership in CHCA District 1199, NUHHCE ("the Union") and agree to abide by its Bylaws (click here to see the CHCA Bylaws) and its Code of Conduct. I authorize the Union, and its successors or assigns, to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours, and other conditions of employement with my employer.
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PAYCHECK DEDUCTION AUTHORIZATION
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Your Employer
You are directed to deduct from any wages earned or to be earned by me as your employee, such amount as may be established by CHCA District 1199, NUHHCE, AFSCME, AFL-CIO, and become due to it, as my membership dues and/or fees or assessments or initiation fees in said Union or such equivalent or related amounts as may be required to fulfill my contractual and lawful obligation. I authorize you to deduct such amounts from one or more of my weekly pay checks each month as required and to remit the same to the Secretary-Treasurer of the Union.

This assignment, authorization and direction shall become effective upon delivery, subject to the check-off provisions of the current Agreement between the above named Employer and the Union, is voluntary and is not conditioned on my present or future membership in the Union.

This assignment, authorization and direction shall be irrevocable for the period of one (1) year, or until the termination of said collective agreement between the Employer and the Union, or any period specified in the applicable collective bargaining agreement, whichever occurs sooner; and I agree and direct that this assignment, authorization and direction shall be automatically renewed, and shall be irrevocable for successive periods of one (1) year each for the period of each succeeding applicable collective agreement between the Employer and the Union, whichever shall be shorter, unless written notice is given by me to the Employer and CHCA District 1199, NUHHCE, AFSCME, AFL-CIO at 2 North Plains Industrial Rd, Wallingford, Connecticut 06492, in the period specified in the applicable collective bargaining agreement of not more than fifteen (15) days and not less than ten (10) days prior to the expiration of each period of one (1) year, or of each applicable collective agreement between the Employer and the Union, whichever occurs sooner.

This authorization is made pursuant to the provisions of applicable law including Section 302(c) of the Labor Management Relations Act of 1947.
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CHCA District 1199, NUHHCE, AFSCME, AFL-CIO

APPLICATION FOR MEMBERSHIP

PAYCHECK DEDUCTION AUTHORIZATION