Local 1002 Authorizations Please enable JavaScript in your browser to complete this form.Name *FirstLast Authorization Layout Name Email *Phone *Classification *Last 4SSN: *Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmployer Name *Job Site Location (City, State) *Authorization For Representation *I authorize Local Union No.1002 of the International Brotherhood of Electrical Workers to represent me, as my National Labor Relations Act (NLRA) Section 9(a) bargaining representative in collective bargaining with present and future employers on all present and future jobsites within the jurisdiction of the Union. This Authorization is nonexpiring, binding, and valid until such time as I submit a written revocation.I do not authorize.Working Assessment Deduction Authorization *I hereby voluntarily authorize and direct the above named employer or its successors and assigns ( the Employer) to deduct from my pay each pay period an amount of dues and initiation fees fixed in accordance with the Bylaws of Local Union 1002 or its successors or assigns ( the Union) and the Constitution of the International Brotherhood of Electrical Workers, or such lesser amount as required by law, and to pay same to the Union in accordance with the terms of the bargaining agreement between the Employer and the Union. When working outside the jurisdiction of the Union, the Employer is authorized to deduct working dues in the amount set forth in the Bylaws of the IBEW Local Union where the work is performed and to pay same to that Local Union. This authorization shall be irrevocable for a period of one year from the date hereof or until the termination date of the bargaining agreement between the Employer and the Union, whichever occurs sooner, without regard to whether I am a member of the Union during that period, and shall automatically renew and be irrevocable for successive periods of one year unless I give the Employer and the Union written notice of revocation during the ten (10) day period prior to the anniversary of this authorization or during the ten (10) day period beginning on the termination date of the agreement, whichever comes first. I recognize that signing this authorization of payroll deductions is not a condition of employment, and that my authorization, and the continuation of such authorization from year to year, is voluntary and applies regardless whether I am a union member. I understand that under current law the payments covered by this authorization are not deductible as charitable contributions for federal income tax purposes.I do not authorize.Signature Clear Signature DateSubmit
Recent Comments