OPEIU 8 Membership App

MEMBERSHIP APPLICATION
I, the undersigned, designate Office and Professional Employees International Union, Local 8, as my chosen and authorized collective bargaining representative on matters relating to wages, hours, and other conditions of my employment.
Name*

First NameMiddle InitialLast Name
Preferred Pronouns
For example: she/hers, he/him, they/them
ADDRESS*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
DATE EMPLOYED:*

MonthDayYear
Date
HOURLY WAGE:*
$USD
HOURS WORKED PER WEEK*
(on average / during a typical week)
Full TimeOn CallPart Time
Day ShiftAfternoon ShiftNight ShiftVaried Shift
In-PersonRemoteHybrid
(PERSONAL/NON-WORK) CELL PHONE
Format: (000) 000-0000.
*By providing my cell phone number, I understand that OPEIU and its affiliates may use automated calling technologies and/or text message me on my cell phone on a periodic basis. Carrier message and data rates may apply to such texts.
(PERSONAL/NON-WORK) EMAIL ADDRESS*
example@example.com
BIRTHDATE [MONTH/DAY/YEAR]*

MonthDayYear
Date
EMPLOYER*
JOB TITLE, DEPARTMENT*
WORKSITE*
BENEFICIARY

Please fill in the info of your beneficiary here.
NAME*
RELATIONSHIP*
PHONE NUMBER*
Format: (000) 000-0000.
MORE ABOUT YOU
AsianBlackHispanic/Latino/aNative AmericanPacific IslanderWhiteBiracialPrefer not to sayOther
Ethnicity:
Language(s) I speak at home:
EnglishSpanishOther
YesNo
Local 8 is proud of our diverse union. Membership in Local 8 is without regard to race, color, national origin, gender, sexual orientation, age, disability status, religion, political belief, or affiliation. We are striving to ensure our leadership is reflective of our membership. We also want to, whenever possible, ensure our communications are accessible to all. To help us accomplish these goals, please share more about yourself to help build our strength and ensure our union is inclusive for everyone.
PAYROLL DEDUCTION AUTHORIZATION
Upon receipt of this authorization, I hereby request and authorize my Employer to deduct from my wages or salary and to transmit to OPEIU Local 8, AFL-CIO the authorized initiation fees and monthly dues or fees as certified in writing by the Union. I direct this authorization will remain in effect and be irrevocable unless I revoke it in writing sent via U.S. mail during the period not less than thirty (30) and not more than forty-five (45) days before the annual anniversary of this agreement. I recognize that this authorization is voluntary and not a condition of employment and shall be automatically renewed from year to year unless I revoke it in writing during the window period, irrespective of my membership in OPEIU 8. If, for any reason, a deduction is omitted, authorization is hereby requested and granted for an additional deduction to be remitted the following month to:

OPEIU LOCAL 8, AFL-CIO, 6000 SOUTHCENTER BLVD, TUKWILA, WA 98188

Union dues are not deductible as charitable contributions for federal income tax purposes.
SIGNATURE:*

Clear
DATE:*

MonthDayYear
Date
Should be Empty:

MEMBERSHIP APPLICATION

BENEFICIARY

MORE ABOUT YOU

PAYROLL DEDUCTION AUTHORIZATION