Teamsters Local Union No 570

Authorization - Teamsters Local Union No. 570

I authorize Teamsters Local 570, affiliated with the International Brotherhood of Teamsters,
as my exclusive bargaining representative for purposes of negotiating for better wages, benefits,
and other terms and conditions of employment.

Please complete the form below entirely.

Name

Phone

Date

Home address, city, state, zip

Email

Employer

Employer's address

Hire Date

Days Off

Day Shift or Night Shift

Full Time or Part Time

Work Classification

Would you like to participate on an Organizing Committee? Please enter Yes or No

Signature:

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

This is not a dues deduction form. Your employer will not have access to this form. It is strictly confidential between you and Teamsters Local 570.

Enter the text shown in the image above.