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FRATERNAL ORDER OF POLICE
Arizona Lodge 44 for Corrections
Membership Application
Using State Payroll Deduction
NAME:
*
First Name
Last Name
DATE OF BIRTH:
*
-
Month
-
Day
Year
Date
MAILING ADDRESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CELL PHONE:
*
Format: (000) 000-0000.
NON-WORK EMAIL:
*
example@example.com
GENDER:
*
MALE
FEMALE
COMPLEX LOCATION:
*
UNIT:
*
RANK:
*
DATE OF HIRE:
-
Month
-
Day
Year
Date
EIN:
*
TAKE A PHOTO OF YOUR DEPARTMENT ID....
...OR UPLOAD DEPARTMENT ID FROM PHONE PHOTOS OR COMPUTER
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FOR FASTER PROCESSING OF YOUR APPLICATION, PLEASE TAKE A PHOTO OF YOUR DEPARTMENT ID, RETIRED ID, OR ARIZONA DRIVER'S LICENSE ABOVE, OR UPLOAD IT FROM YOUR PHONE/COMPUTER HERE
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ARE YOU CURRENTLY UNDER INVESTIGATION?
*
NO
YES
WHAT TYPE OF INVESTIGATION IS IT?
ON DUTY ADMINISTRATIVE (AI)
ON DUTY CRIMINAL (CIU INVOLVEMENT)
OFF DUTY ADMINISTRATIVE (AI)
OFF DUTY CRIMINAL (POLICE INVOLVEMENT)
OFF DUTY TRAFFIC TICKET
OFF DUTY CRIMINAL TRAFFIC TICKET
EEO
Other
DID YOU ALREADY RECEIVE AN (AI) 601 FORM?
NO
YES
UPLOAD (AI) 601 COMPLAINT
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This is an application for the Fraternal Order of Police, Lodge 44 Membership. Fraternal Order of Police, Lodge 44 Dues are $17.00 per pay period ($34 per month) which includes our legal plan. If you chose PAYROLL DEDUCT, your membership will not start until your PAYROLL DEDUCT is turned in to your Personal Office and payment is received by the Arizona Legal Council. In signing this application you also attest to the following:
I hereby apply for membership in the Fraternal Order of Police/Arizona Labor Council, Inc. (FOP/ALC). I authorize the FOP/ALC to act as my official representative in job related matters concerning my wages, hours, and conditions of employment in order to promote and protect my economic welfare.
Further, I do solemnly and sincerely promise and swear, that I will, to the best of my ability, comply with all the laws and rules of this Order; that I will recognize the authority of my legal elected officers and obey all orders therefrom not in conflict with my religious or political views, or my rights as an American citizen; that I will not cheat, wrong, or defraud this Order, or any member thereof, or permit the same to be done if in my power to prevent it; that I will, at all times, aid and assist a worthy Brother or Sister in sickness or distress, so far as it lies in my power to do so; that I will not divulge any of the secrets of this Order to anyone not entitled to receive them. To all of which I most solemnly and sincerely promise and swear. Should I violate this, my solemn oath of obligation, I hereby consent to be expelled from the Order. This application for FOP membership will not become effective until approved by the FOP Lodge 44 Membership. Legal coverage will be effective when payment is received by FOP/ALC via payroll deduction. (normally 30 days after turning into payroll liaison)
DO YOU NEED TO DROP FROM ANOTHER UNION?
APA/ACA
AZCPOA
SIGNATURE:
*
APPLICATION DATE:
-
Month
-
Day
Year
Date
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STATE OF ARIZONA AUTHORIZATION TO START, CHANGE, OR STOP A VOLUNTARY DEDUCTION
I hereby request and authorize the State of Arizona to deduct from my pay any deductions I have indicated above as a start or change. I hereby request and authorize the State of Arizona to stop deducting from my pay any deductions I have indicated above as a stop. This authorization will remain in effect until a new authorization is received. I understand that deductions occur on the first and second paydays of the month (24 times per year) unless indicated with a star (*) which occur every payday (26 times per year).
EMPLOYEE'S (YOUR) SIGNATURE:
*
DATE:
-
Month
-
Day
Year
Date
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