UFCW

Authorization for Representation Under the National Labor Relations Act and/or Any State Law Governing Worker Unionization

I authorize the UFCW or its designated International Chemical Workers Union Council or local union to represent me in all matters relating to collective bargaining. This authorization supersedes any similar authority previously given to any person or organization.

First Name*

Last Name*

Pronouns

Cell Phone / Home Phone*

Email Address *

Home Address*

City*

State or Province*

Postal Code*

Company Name*

Hire Date*

Work Location*

Work Shift*

*We will send you a message to confirm we received your card.