Join UE Local 119 —Application for Membership— Yes, I want to join and become a member of UE Local 119 to improve my workplace and my community. I hereby request and accept membership in the United Electrical, Radio & Machine Workers of America (UE) and authorize it to represent me, and in my behalf to negotiate and conclude all agreements as to hours of labor, wages, and all other conditions of employment. Name (required) Email (required) Phone (required) Department (required) Job Title (required) Shift Pay Rate (required) Schedule (required) Full-timePart-time Address (required) Street City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip —Check-off Authorization— TO: ESS Support Services Effective Date: I recognize the need for a strong, independent, democratic, rank and file union and believe that all workers represented by the UE should pay their fair share to financially support our union. You are hereby authorized and directed to deduct from my weekly pay, an amount equivalent to dues, fees, assessments and initiation fees as shall be certified by the United Electrical, Radio & Machine Workers of America (UE) Local 119 and remit the same to the UE. This authorization and assignment is voluntarily made as an administrative convenience to facilitate payment of dues, fees, assessments, and initiation fees. This authorization and assignment shall be irrevocable for a period of one (1) year from the date I sign this card or until the end of the current collective bargaining agreement between my Employer, its successors (including, but not limited to, Burns successors) and assigns, and the Union, whichever occurs sooner, and from year to year thereafter, unless I give the Employer and the Union written notice to stop deducting payments under this agreement, postmarked within seven (7) days before the end of the one year period or postmarked seven (7) days before the end of the collective bargaining agreement. I understand that the Employer will stop deducting, and the Union will stop receiving, my wages effective the month after the month in which written notice of revocation is given. Revocation shall be effective only if I give the Employer and UE Local 119 written notice, and it is received or postmarked during the period specified above. This authorization will remain in effect in the event that I am laid off, leave work on a leave of absence, or separate from employment with my present Employer. I authorize deductions to resume upon the resumption of employment as a new hire or otherwise. Signature (required) I agree that I entered my name correctly in the "Name" field above and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.