Lehigh Acres MSID PERC Application

Lehigh Acres Municipal Services Improvement District PERC Application Form

Please complete ALL required (*) fields.
FIRST NAME*
MIDDLE NAME
LAST NAME*
Social Security Number*
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Phone*
Have you ever been a member of a Teamster Local Union?

YESNO
If yes, what Local Union Number?
CLASSIFICATION NAME (Class Title)*
Hourly Rate of Pay*
Monthly Dues Rate
Employment date

MonthDayYear
Date
To become (and remain) an active Teamster member, you must remit dues to Teamsters Local 79 yourself.

Your employer is no longer allowed to deduct dues from your paycheck.
Please check the box below that applies to your desired method of payment:*

I will be paying by check, cash, or money order. Mail payment to: Teamsters Local 79, 5818 E. Dr. MLK Jr. Blvd., Tampa, FL 33619I will be paying by setting up a bill pay account through my bank.I will be paying by credit/debit card. Pay by calling 813-621-1391 ext.3I will be paying by ACH/EFT using my bank account on an automatic/recurring monthly basis. If using this option, complete the following fields:
Enter your banking information for self-payment of Union dues.
Bank Name
Account Type

CheckingSavings
Routing Number
Bank Account Number
THE STATE OF FLORIDA WANTS YOU TO KNOW THE FOLLOWING:
The State of Florida is a right-to-work state. Membership or non-membership in a labor union is not required as a condition of employment, and union membership and payment of union dues and assessments are voluntary. Each person has the right to join and pay dues to a labor union or to refrain from joining and paying dues to a labor union. No employee may be discriminated against in any manner for joining and financially supporting a labor union or for refusing to join or financially support a labor union.
Date of Signature
Signature*

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Lehigh Acres Municipal Services Improvement District PERC Application Form

To become (and remain) an active Teamster member, you must remit dues to Teamsters Local 79 yourself.

THE STATE OF FLORIDA WANTS YOU TO KNOW THE FOLLOWING: