Authorization for Representation

I hereby designate Local Union No. 1329 of the Laborers’ International Union of North America, as my collective bargaining representative in all matters pertaining to the terms and conditions of my employment. This authorization applies to my present Employer and all my future Employers. This authorization is signed by me for the purpose of securing for the Union recognition and negotiation rights with my Employer and with any future Employer. It may be revoked only by me, through written notice to the Union.

Name

First Middle Last

Signature

Date

Name of Employer(Required)

Telephone Number(Required)

Cell Phone Number

Address(Required)

Street Address Address Line 2 City State ZIP Code

By providing your email and phone, you confirm your consent to receive messages from LIUNA & its affiliates, including any autodialed call, text message or email, about important matters, including your contract, benefits, union operations, political, and legislative matters. You can opt-out at any time.

Union dues are not deductible as charitable contributions for Federal income tax purposes. However, they may be tax deductible under other provisions of the Internal Revenue Code. Union dues may qualify as business expenses, job-related expenses, or other “unreimbursed employee expenses” to the extent permitted by the Internal Revenue Service.

v.1, updated 10/18

Phone

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