MEMBERSHIP APPLICATION LINK REQUEST FORM

MEMBERSHIP APPLICATION LINK REQUEST FORM
Please complete the form below to request a secure link to your union membership application. Once submitted, you will receive a text with a unique link from sidekick-app.ufcw.org with instructions on how to complete and submit your application online.

Required Information:
- Full Name
- Address
- SS#
- Employee ID #
- Email Address
- Cell Phone Number
- Employer/Worksite
- Job Title
By submitting this form, you request access to the official membership application for UFCW LOCAL 1167. If you have any questions or need assistance, please contact 909-877-5000.
Name*

First NameMiddle InitialLast Name
Sex
Date of Birth*

MonthDayYear
Social Security Number*
Employee ID*
Home Address*
Apt
City*
State*
Zip Code*
Cell Phone*
Cellular Phone Number
Home Phone
Home Phone Number
EMAIL*
example@example.com
Are you a Registered Voter
Marital Status
Job Status*
Choose FT or PT
Company Name*
Store Number*
Store City*
Date of Hire*

MonthDayYear
Job Classification*
Prev Local Union
Withdrawal Date from Previous Local Union

MonthDayYear
Date Submitted*

MonthDayYear
Should be Empty: