WFSE Dual Authorization Card for External Organizing

Washington Federation of State Employees | AFSCME Council 28 | AFL-CIO

YES! I want to be a Union member, and I authorize the Washington Federation of State employees AFSCME Council 28 as my exclusive representative for the purposes of collective bargaining.

Authorization

In signing this card, I authorize the Washington Federation of State Employees AFSCME Council 28 as my exclusive bargaining representative for the purpose of collective bargaining. I understand that in signing this card, I am making a show of interest that may be used for purposes of a cross-check election under Chapter 391-25 WAC and that this card may be used to obtain certification of the Washington Federation of State Employees AFSCME Council 28 as the exclusive bargaining representative without a secret ballot election. I have the right to ask the agency to revoke my authorization for purposes of cross-check of records.

Upon becoming covered by a Washington Federation of State Employees AFSCME Council 28 collective bargaining agreement, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, an amount equivalent to dues as set in accordance with the Washington Federation of State Employees AFSCME Council 28 Constitution and By-Laws and authorize my Employer to remit such amount semi-monthly to the Union (currently 1.5% of my salary per pay period not to exceed the maximum). This voluntary authorization and assignment shall be irrevocable for a period of one year from the date of execution and automatically renews year to year thereafter unless I give the Union written notice of revocation prior to the end of any yearly period, regardless of whether I am or remain a member of the Union, unless I am no longer in active pay status in a Washington Federation of State Employees AFSCME Council 28 bargaining unit. This card supersedes any prior check-off authorization card I signed. I understand the Union only accepts instructions or requests regarding my membership sent directly from me to the Union and will not process anything sent by third parties or other representatives. I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.

First Name

Middle Initial

Last Name

Nickname

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Birthdate

Employer

Date of Hire

Personal Email

Work Email

Work Phone

Cell Phone †

† By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME Council 28 on any subject matter. My carrier’s rates may apply. I may modify my preferences by calling the Union at 833-MCC-WFSE or emailing the Union at [email protected].

Signature

THIS IS A REQUIRED FIELD. For your submission to be counted, you must place your signature here.

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