Authorization for Representation Under the National Labor Relations Act
I, the undersigned employee of
Company Name
*
Address of Company
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorize the International Brotherhood of Teamsters (or one of its chartered Teamster Local Unions) to represent me in negotiations for better wages, hours and working conditions.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Job Classification
*
Department
*
Shift
*
Signature
*
This is not a dues deduction card
Submit
Should be Empty: