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AUTHORIZATION FOR REPRESENTATION UNDER SECTION 111.70 OF WISCONSIN STATUTES (PUBLIC SECTOR)
I,
First Name:
Last Name:
Telephone:
Your Home Address:
City, State:
,
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip Code:
Employed At:
(Enter Full Name of Employer)
Employer's Address:
City, State:
,
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip Code:
Job Title:
Shift Designation Check one:
First Shift
Second Shift
Third Shift
hereby designate the General Teamsters Local Union 662, affiliated with the International Brotherhood of Teamsters, to petition for a representation election and/or voluntary recognition and to represent me for the purpose of collective bargaining as provided under Section 111.70 of Wisconsin Statutes.
Signature:
Use your mouse, finger, or touch device to write your signature.
Clear
Date:
Home Phone No:
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Contact Info
TEAMSTERS LOCAL UNION 662
,
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