AUTHORIZATION FOR REPRESENTATION UNDER THE NATIONAL LABOR RELATIONS ACT

I, First Name:

Last Name:

Occupation or Job Description:

Telephone:

Your Home Address:

City, State: , AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY

Zip Code:

Employed At: (Enter Full Name of Company)

Company Address:

City, State:  , AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY

Zip Code:

hereby designate the TEAMSTERS GENERAL UNION, LOCAL No. 662, MOSINEE, WISCONSIN, affiliated with the Brotherhood of Teamsters, to represent me for the purpose of collective bargaining and in any and all situations that may arise under the operation of the National Labor Relations Act, and/or with any individual employer where the provisions of the National Labor Relations Act are not invoked, and to negotiate in my behalf a labor agreement covering wages, hours and working conditions.

Shift Designation Check one: First Shift  Second Shift  Third Shift

Signature: Use your mouse, finger, or touch device to write your signature. Clear

Date:

Home Phone No: