Application for Membership

Voluntary Dues Authorization and Membership Application 

Employees represented by the Communications Workers of America (CWA), AFL-CIO

Authorization for Dues Deduction for CWA 4501, AFL-CIO

I, (PRINT FIRST, MIDDLE INITIAL, LAST) ________________________________________________, hereby authorize my employer:

Check one:  ____OSU (& Branches)    ____Ohio Secretary of State   _____ Pickaway Co. Job & Family Services 

 to deduct from my pay, until this authorization is revoked in writing by me, commencing in the month following the receipt of this authorization by employer, union dues or dues equivalency in the amount provided for in the constitution and by-laws of CWA.  This authorization of dues or dues equivalency deduction shall be irrevocable except that revocation of any such authorization shall be effective only if an employee gives written notice of such revocation to the given employer’s  payroll office with a copy to the Local Union, sent by 
Registered or Certified Mail, post-marked within the applicable window for withdrawal, which shall be not more than ten (10) days and not less than one (1) day prior to the anniversary date of the execution of this agreement or the termination date of the collective bargaining agreement, whichever shall occur sooner, and, thereafter, during the same prescribed time-frame prior to each subsequent anniversary of any collective bargaining agreement.  I authorize this agreement to continue in effect irrespective of my membership status.

Signature_______________________________________ Employee ID No. __________________ Date _____/_____/______

                                                                                                                                            MONTH     DAY        YEAR

***Union membership dues are not deductible as charitable contributions for Federal income tax purposes.  Dues, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code.

CWA LOCAL 4501 MEMBERSHIP APPLICATION

PRINT NAME_________________________________________________   EMPLOYEE ID No________________________________

I hereby apply for membership in the Communications Workers of America and agree to abide by its constitution and the by-laws of the local to which I belong.

Date______/______/_______ Signature _________________________________________ Job Title__________________________

Hm. Address ________________________________________________ City/State/zip_____________________________________

Cellph_____________________________ Hmph__________________________ Email (non-employer) ________________________

Office use only    Received__________       OHR____               Aptify_____          MCsent_____         Sever________

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