Authorization for Representation

Authorization for Representation

This digital card authorizes Teamsters Local 743, affiliated with the International Brotherhood of Teamsters, to represent me for the purpose of collective bargaining relating to and respecting wages, hours, and other terms and conditions of employment with my current or future employer within the jurisdiction of the Union. I understand this authorization can be used by the Union to obtain recognition without an election. I further understand that no dues or initiation fees are payable by me until a contract is signed.
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Worker Information
Full Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Employment Information
Current Employer
Employee ID
Current Hourly Rate
Approx.
Location
Evanston Hospital, Skokie Immediate Care at Old Orchard Woods, etc.
Unit/Work Area
3N, ED, ISCU, GI LAB, etc.
Title/Classification
Registered Nurse, Cancer Care Collaborative Nurse, etc.
Shift/Start Times
Days, 8a-4p, etc. (Approx.)
Typical Days Worked Per Week

Other
Signature
Should be Empty:

Note: Read Before Signing