HR Union Card Template

HR Union Membership Card and Authorization

Personal Information

Full Legal Name:

Date of Birth:    Employee ID:

Position Information

Department:    Reporting Manager:

Date of Hire:    Work Location:

Union Membership Details & Authorization

Union Name:    Local/Chapter No.:

Membership Type: Regular Associate Retired

Membership Effective Date:

Dues Authorization: I hereby authorize my employer to deduct from my pay the amount of regular membership dues, initiation fees, assessments, and related membership obligations as certified to the employer by the union. This authorization is conditioned upon the union providing written notice of the amount and changes to dues to the employer.

I authorize payroll deduction for union dues and assessments as certified to my employer by the union.

Political Action / PAC Contribution: I consent to voluntary contributions for political or legislative purposes where permitted. Contributions are separate from regular dues and require separate authorization.

Revocation: This authorization shall remain in effect until revoked by me in a signed written notice delivered to my employer and the union in accordance with applicable law and collective bargaining provisions. Revocation does not affect any amounts already deducted.

Representation, Benefits and Acknowledgements

Representation: By signing this card I acknowledge that the named union is the exclusive bargaining representative for employees in the bargaining unit described by the collective bargaining agreement. I understand that union membership includes the right to representation under that agreement for covered matters.

Benefits: Membership may entitle me to union-administered benefits. Eligibility, enrollment procedures, and benefit specifics are governed by the union and benefit plan documents.

Employment History

Title:    Dates Employed:

Title:    Dates Employed:

Education

References

Phone:    Email:

Phone:    Email:

Phone:    Email:

Legal Disclosures

At-Will Employment: Nothing in this card or membership authorization alters the at-will employment relationship between the employer and the employee, except where a collective bargaining agreement or binding contract specifies otherwise.

Equal Opportunity: The union and employer maintain policies prohibiting discrimination and harassment. Membership in the union shall not be conditioned on race, color, religion, sex, national origin, age, disability, or other protected characteristics.

I certify that all information provided on this card is true, complete, and accurate to the best of my knowledge. I understand that any false statement may be grounds for denial of membership or disciplinary action consistent with applicable collective bargaining agreements and employer policies.

Authorization to Verify: I authorize the union and my employer to contact my previous employers and listed references, and to conduct background checks and verification of employment, education, and other relevant information necessary to process this membership application and any associated benefit enrollments. I release those parties from liability for providing such information in good faith.

Personal information collected on this card will be used for membership administration, dues processing, representation, and benefit eligibility. It will be retained and disclosed only as necessary for these purposes or as required by law.

Sign Now