Organize Your Work Place

First name

Last name

Address 1

Address 2 (optional)

City

Province
British ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNewfoundlandNova ScotiaNew BrunswickPEINunavutNorthwest TerritoriesYukon Territory

Postal Code

Telephone Number

Employer

Job Classification

Applicant email

Date at time of application

In applying for a membership I understand that the Union intends to apply to be certified as my exclusive bargaining agent and to represent me in collective bargaining. I, the undersigned, hereby authorize and request my employer to deduct from my salary once each month, an amount equal to the current monthly dues and/or assessments.

Signature (type full name)

All information obtained will be kept confidential.