Teamsters Electronic Authorization for Representation

Authorization for Representation Under the National Labor Relations Act

Complete this secure, multi-step authorization on your phone, then submit to receive a confirmation email.
I, the undersigned employee of
Company
Address of Company

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Authorize the International Brotherhood of Teamsters (or one of its Chartered Teamster Local Unions or National Bargaining Committee) to represent me in negotiations for better wages, hours and working conditions.
(PLEASE PRINT)
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip
Use your personal e-mail address and personal phone number, not contact information provided or controlled by your employer.
E-mail
Use your personal contact information, not an employer-provided account or number.
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Job Classification
Shift
Acknowledgment
Signature
This is not a dues deduction card
You Have The Right to ORGANIZE!
“Employees shall have the right to form, join, or assist labor organizations (unions), to bargain collectively through representatives of their own choosing...” —National Labor Relations Act, Sec. 7
UNDER THE LAW, the government guarantees your right to: • help form or join a union • bargain over wages, benefits and working conditions with your employer • have small group meetings at lunchtime or break time in a non-work area • talk about the union on your own time • distribute literature in non-work areas on non-work time • attend union meetings without interference from your boss • wear union buttons • solicit other employees for union membership, both on lunch or break—even on company property such as break rooms and parking lots
An employer may not discriminate against you for exercising these rights.
IT IS ILLEGAL FOR YOUR EMPLOYER OR SUPERVISOR TO:
Organizer’s Initials
• threaten or coerce you • threaten to close the facility if the union is voted in • bribe or promise special favors to employees to vote against the union • deny you the right to vote for union representation • spy on your union activities • ask you about your union activities or attitude • fire, transfer, demote or discipline you (or lay you off) in retaliation for union activities
Organizer Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Campaign ID
Intended Teamster Local
Joint Council or Division
Organizer Name

First NameLast Name
Should be Empty:

Authorization for Representation Under the National Labor Relations Act

You Have The Right to ORGANIZE!

IT IS ILLEGAL FOR YOUR EMPLOYER OR SUPERVISOR TO: