Teamsters 769 UPS Member Application

UPS Employees Member Application

Teamsters Local Union No. 769
NOTE: This application for representation is for employees of United Parcel Service ONLY!
Date of Application

MonthDayYear
Date
I, the undersigned, hereby apply for admission to membership in the above Local Union and voluntarily choose and designate it as my representative for purposes of collective bargaining. hereby revoking any contrary designation. If admitted to membership, I agree to abide by the Constitution of the International as well as the Local Union By-laws which are not in conflict with International laws and thereupon accept and assume the following oath of obligation: I pledge my honor to faithfully observe the Constitution and laws of the International Brotherhood of Teamsters, Chauffeurs. Warehousemen and Helpers of America. I pledge that I will comply with all the rules and regulations for the government of the International Union and this Local Union. I will faithfully perform all the duties assigned to me to the best of my ability and skill. I will conduct myself at all times in a manner as not to bring reproach upon my Union. I shall take an affirmative part in the business and activities of the Union and accept and discharge my responsibilities during any authorized strike or lockout. I will never discriminate against a fellow worker on account of creed, color, or nationality. I will at all times bear true and faithful allegiance to the International Brotherhood of Teamsters. Chauffeurs, Warehousemen and Helpers of America and this Local Union.
Name*

(First Name)(Middle Initial)(Last Name)
Full-time or Part-time?
Cell Phone*
Home Phone (Landline)
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Social Security No.
Street Address*
City*
State*
Zip Code*
Are you registered to vote?

YesNo
Precinct
Is a Teamsters 769 Steward assisting you with this application?

YesNo
Steward Name (first initial, last name)
Employer
Employment Date

MonthDayYear
Date
Worksite*
Employer Phone
Rate of Pay
Have you ever been a member of a Teamster Local Union?

YesNo
If Yes, which Local number?
Signature of Applicant*

Clear
CHECK-OFF AUTHORIZATION AND ASSIGNMENT
I, the undersigned member of Local 769, of the International Brotherhood of Teamsters, Chauffeurs, Warehousemen and Helpers of America hereby authorize my employer to deduct from my wages and to pay to Local No. 769 and/or its authorized representative, initiation fees and membership dues, fee equal to dues/in lieu of membership, including uniform assessments in such amounts as may be established by such Local Union from time to time and in accordance with the agreement between such Local Union and my employer.

This authorization and assignment shall be irrevocable for the term of the applicable contract between the Union and the Company, or for one year. whichever is lesser, and shall automatically renew itself for successive yearly or applicable contract periods thereafter, whichever is the lesser, unless I give written notice to the Company and the Union at least 10 days and not more than 20 days before any periodic renewal date of this authorization and assignment of my desire to revoke the same. Union dues are not deductible as charitable contributions for Federal Income Tax purposes.
Date*

MonthDayYear
Date
Dues Checkoff Signature*

Clear
Please verify that you are human*
Should be Empty:

UPS Employees Member Application

CHECK-OFF AUTHORIZATION AND ASSIGNMENT