• Membership Application

    Employee Authorization For Payroll Deduction Of Union Dues

    For CWA 3176

    *Last Name                 *First Name        

    *SSN                           *Employee ID    

    *Dept                            Local Number    CWA 3176

    *Work Address       (city/state/zip)

    I hereby authorize Employer*, to deduct from the compensation (including disability benefits or vacation payments) due me once an amount equal to the initiation fee certified in writing to the Company by the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent, and each month an amount equal to regular monthly Union dues, certified in writing to the Company by the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. Each amount so deducted shall be remitted to the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. If for any reason the Company fails to make a deduction, I authorize the Company to make such deduction in a subsequent payroll period. This authorization is voluntarily made and is neither conditioned on my present or future membership in the Union nor is it to be considered as a quid pro quo for membership. This authorization shall continue in effect until canceled by written notice signed by me and individually sent to the Company and to the Union. This cancellation of authorization must be postmarked during the fourteen (14) day period prior to each anniversary date of the current or any subsequent Collective Bargaining Agreement, or during the fourteen (14) day period prior to the termination of the current or any subsequent Collective Bargaining Agreement.

    ______________________________________________

    (Signature of Employee Authorizing Deduction)

    *(Date) 

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

                                                                                                                                                                                                                                                                           COMPANY COPY

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     CWA 3176 MEMBERSHIP APPLICATION

    *Full Name:                     

    Your name above will be displayed on your union card.

    *Home Mailing Address:    

    *Personal Email:               

    *Social Security Number:            *Employee ID       

    I hereby request and accept membership in the COMMUNICATIONS WORKERS OF AMERICA and when accepted by the Local, agree to be bound by the Constitution of the Union and Amendments thereto and Rules and Regulations now in effect or subsequently enacted by the Union and/or the Local to which I am assigned.

    *Date                  *New Member Signature (print): 

    *Company: 

    _______________________________________________________

    AUTHORIZING SIGNATURE 

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

                                                                                                                                                                                                                                                          LOCAL COPY

    A signature is required for your application to be processed.

    Signing the box below will place your signature in the highlighted sections of this form on the PDF the Secretary will receive. 

    Signature:

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

                                                                                                                                                                                                                                                                       


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