CCSD CHECKOFF AUTHORIZATION AND ASSIGNMENT-Teamsters Local 14

Application and Bargaining Authorization

General Sales Drivers, Delivery Drivers and Helpers, Teamsters Local Union #14 - Affiliated with the International Brotherhood of Teamsters
I, the undersigned herby apply for admission to membership in the above Local Union and voluntarily choose and designate it as my representative for purposes of collective bargaining, hereby revoking and contrary designation. If admitted to membership, I agree to abide by the Constitution of the International as well as the Local Union Bylaws which are not in conflict with International laws and thereupon accept and assume the following oath of obligation: I pledge my honor to faithfully observe the Constitution and laws of the International Brotherhood of Teamsters. I pledge that I will comply will all the rules and regulations for the government of the International Union and this Local Union. I will faithfully perform all the duties assigned to me to the best of my ability and skill. I will conduct myself at all times in a manner as not to bring reproach upon my Union. I shall take an affirmative part in the business and activities of the Union and accept and discharge my responsibilities during any authorized strike or lockout. I will never discriminate against a fellow worker on account of creed, color or nationality. I will at all times bear true and faithful allegiance to the International Brotherhood of Teamsters, and this Local Union.
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Occupation:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number:
Employer: CCSD Street: 5100 W. Sahara Ave.

City: Las Vegas State: NV

Zip Code: 89146 Phone: (702) 799-5000
Current Hourly Wage:
Employment Date:

MonthDayYear
Date
Initiation Fee: $
Paid To:
All Initiation money left on deposit by default of applicant shall be considered forfeited in 30 days.
Have you ever been a member of a Teamsters Local Union?

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Date of Application:

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CHECKOFF AUTHORIZATION AND ASSIGNMENT

General Sales Drivers, Delivery Drivers and Helpers, Teamsters Local Union #14 Affiliated with the International Brotherhood of Teamsters
I,

First NameLast Name
hereby authorize and direct my Employer every month to deduct from my wages all initiation fees, reinitiation or reinstatement fees, membership dues and uniform assessments as required by Teamsters Local No. 14 or its legal successor. I further authorize and direct that these monies so deducted be turned over each month to the Secretary-Treasurer of Teamsters Local No. 14.

This authorization and assignment shall be irrevocable for a period of one year or until the termination of the applicable collective bargaining agreement, whichever occurs first, and shall therefore be automatically renewed for successive periods of one year or until the termination of the applicable collective bargaining agreement, whichever occurs first, unless written notice is given by me to my Employer and the Union at least 60 days but not more than 75 days prior to the expiration of each one year period or of the applicable collective bargaining agreement, whichever occurs first. Union dues are not deductible as charitable contributions for Federal Income Tax purposes.

This authorization and assignment is made pursuant to Section 302 of the national Labor Relations Act, as amended, and is in full force and is in full force and effect to the extent permitted by the act.
Signature

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Date:

MonthDayYear
Date
Social Security Number:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer: CCSD, 5100 W. Sahara Ave., Las Vegas, NV 89146
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Application and Bargaining Authorization

CHECKOFF AUTHORIZATION AND ASSIGNMENT