Teamsters Local 317

I voluntarily submit this Application for Membership in Local Union 317, affiliated with the International Brotherhood of Teamsters. In joining the Union, I recognize that the Union's strength and ability to represent my interests at work depends on my exercising my right, as guaranteed by the law, to join the Union and engage in collective activities with my fellow workers. I understand that by becoming and remaining a member of the Union I may fully participate in the activities of the Union, be entitled to attend membership meetings, participate in the development of contract proposals for collective bargaining, vote to ratify or reject collective bargaining agreements, run for Union office or support candidates of my choice, receive Union publications and take advantage of programs available only to Union members.

I understand that under the law, I may elect not to join the Union and not pay Union dues or fees. By not joining the Union, I sacrifice the rights described above to participate in Union affairs.

I have read and understand the options available to me and submit this application to be admitted as a member of Teamsters Local 317.

First Name *

Last Name *

Middle Initial

Occupation *

Phone *

Email Address *

Address *

City *

State *

Zip Code *

Employer *

Employement Date *

Employer Phone *

Employer Street *

Employer City *

Employer State *

Employer Zip *

Current Wage *

Initiation Fee $

Paid To

Birth Date *

SSN *

Have you ever been a member of a Teamster Local Union?

If yes what local number?

Date of Application *

CHECKOFF AUTHORIZATION & ASSIGNMENT *

The undersigned hereby voluntarily and freely consents to authorizing my employer to deduct from paycheck(s) each and every month an amount equal to my monthly dues, initiation fees, and uniform assessments of Teamsters Local 317 ("Union"), and direct such amounts so deducted to be turned over each month to the Secretary-Treasure of Teamsters Local 317 or his/her designee for and on my behalf. This authorization and assignment shall be irrevocable for the term of the applicable contract between the Union and my employer or for one year, whichever is less, unless I give written notice to the employer and the Union at least sixty (60) days, but not more than (75) days before any periodic renewal date of this authorization and assignment of my desire to revoke the same.

Signature *

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Social Security Number *

Address *

City *

State *

Zip Code *

Employer *

Date *

* Required Fields

(Checkoff Authorization and Assignment - Public Sector)