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Voluntary Authorization for Payroll Deduction

For Transport Workers Union of American, LOCAL 320, AFL-CIO


I hereby authorize the Company to deduct every payroll period from my earnings sum, as the company, in a manner to be determined, is advised from time to time by the Secretary Treasurer of the Transport Workers Union of America, Local 320, to be due the Union under the terms of the Union Constitution and Bylaws, and to remit the amount to the Secretary Treasurer, such sum to be full payment of membership dues per payroll period or as fees equal to the sum required by a Union Member. This authorization and assignment shall be irrevocable for a period of one year from the date of execution or until the termination of the current agreement between the Company and said Union, whichever occurs sooner. The Authorization shall be automatically renewed and shall be irrevocable for successive periods of one year each, or for the period of each succeeding applicable collective bargaining agreement, whichever shall be shorter, unless revoked by me in writing during the period of ten days immediately preceding the termination date of each period of one year of each applicable collective bargaining agreement, whichever period shall be shorter.

Member Acknowledgement
This is the formula currently used to calculate monthly dues: Full-Time: ((Hourly rate x 12 months) x 2 hours)/26 pay periods = Dues/check eg: An employee making $18.00/hr pays $16.62 each pay period eg: ((18.00 x 12) x 2)/26 = $16.62. Part-Time and seasonal employees pay half the FT rate (only 1 hour per month). The formula used is subject to change at any time as long as it abides by the TWU International Constitution and the TWU Local 320 By-Laws. You are authorizing the employer to make a post-tax deduction from your scheduled earnings every pay period on behalf of TWU Local 320. Do you understand?*
First Member Name

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First Member Date of Birth*
First Member Signature*
Second Member Name

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Second Member Date of Birth*
Third Member Name

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Third Member Date of Birth*
Fourth Member Name

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Fourth Member Date of Birth*
Fifth Member Name

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Fifth Member Date of Birth*
Sixth Member Name

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Last Name*
Sixth Member Date of Birth*
Seventh Member Name

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Seventh Member Date of Birth*
Eighth Member Name

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Eighth Member Date of Birth*
Ninth Member Name

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Ninth Member Date of Birth*
Tenth Member Name

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Tenth Member Date of Birth*
City and System
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Employee ID
Parent or Guardian's Email Address

Email*

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

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Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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