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UNION FORM
YOUR TITLE OF ___________________________________________________________ IS
COVERED BY _____________________________________________________________
IF YOU NEED FURTHER INFORMATION CONTACT YOUR SHOP STEWARD.
___________________________________________ ____________________________
SIGNATURE-EMPLOYEE DATE
___________________________________________ ____________________________
SIGNATURE –PERSONNEL REPRESENTATIVE DATE
IF YOU ARE CHANGING UNIONS OR ENTERING SERVICE WITH THE
DEPARMENT OF CORRECTION FOR THE FIRST TIME IT IS NECESSARY FOR YOU TO CONTACT YOUR NEW UNION TO REQUEST
MEMBERSHIP CARDS. RETURN THEM TO YOUR UNION WITHOUT DELAY TO EFFECTUATE YOUR UNION BENEFITS.
THE TELEPHONE NUMBER FOR YOU UNION IS:
( ) _______ - ______________
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