Application of Membership/Benefits Enrollment
I request to become a member of Local Union 39 chartered by the Office and Professional Employees International Union. I hereby make application for admission to membership and enroll in certain benefits offered exclusively through OPEIU. I authorize such organization to be my exclusive Bargaining representative.
"I pledge my honor to faithfully comply with the constitution, laws, and all amendments thereto, of Office and Professional Employees Union, Local No. 39, and of the International Union. I further promise not to divulge or make public any of the private proceedings of this Union, to faithfully perform all the duties assigned to me to the best of my ability and skill; to so conduct myself at all times as not to bring reproach upon my Union."
Name:
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Date of Birth:
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Street Address:
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City:
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State:
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Zip code
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Phone:
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Format: (000) 000-0000.
Personal Email:
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example@example.com
Date of Hire:
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Month
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Day
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Please make your best estimate if not known.
Job Title:
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Signature:
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Date:
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Dues Authorization
I, the undersigned member of Madison Local 39 of the Office & Professional Employees International Union herewith authorize my employer to deduct from my wages each and every month my union dues and direct that such amount so deducted be sent to the Secretary-Treasurer of this Local Union for an on my behalf.
This Authorization and assignment shall be irrevocable for the term of the applicable contract between the Union and the Company or for one year, whichever is the lesser, and shall automatically renew itself for successive yearly or applicable contract periods thereafter, whichever is the lesser, unless I give written notice to the Union at least two days and not more than five days before any periodic renewal date of this Authorization and Assignment of my desire to revoke the same.
Union dues are not deductible as charitable contributions for federal tax purposes.
Initiation fees shall be waived for any employee who provides proof of previous membership in any AFL-CIO affiliated union, provided that previous membership was in good standing.
Employee Name:
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Signature:
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Today's Date:
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Dues rates are set by the OPEIU Local 39 Constitution and associated Dues Policy. Dues for UIC unit set to Per Capita Tax + Strike & Defense + $20.00, rounded to nearest whole. Dues are deducted from the 1
st
and 2
nd
payrolls of each month.
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