Hillsborough Area Regional Transit Authority PERC Application

Hillsborough Area Regional Transit Authority 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
H.A.R.T. has filed a waiver with the Public Employees Relations Commission in accordance with the new legislation which has been granted/approved. Therefore, your union dues will be deducted from your paycheck and remitted to Teamsters Local 79 on your behalf. Feel free to contact the Teamsters Local 79 bookkeeper with any questions you may have @ (813) 621-1391, Ext. 3.
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*

Powered by Jotform SignClear
Employer
Should be Empty:

Hillsborough Area Regional Transit Authority PERC Application Form

THE STATE OF FLORIDA WANTS YOU TO KNOW THE FOLLOWING: