Private Sector Membership Card

YES! I want to join our union so we can win respect, better wages and a voice on the job.

First Name *

M.I.

Last Name *

Home Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Personal Email Address *

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 and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences by emailing [email protected] or calling the Union at 609.586.9093.

Home Phone

Social Security Number * Last four digits only (XXX-XX-1234)

Local Number *

Employer *

Occupation/Job Title *

Department

Worksite

Authorization

I hereby apply for membership in AFSCME New Jersey, Council 63 (hereafter the “Union”) and I agree to abide by its Constitution and Bylaws. I authorize the Union and its successor or assign to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my Employer.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, regardless of whether I am or remain a member of the Union, the amount of dues certified by the Union, and as they may be adjusted periodically by the Union, and to authorize my Employer to remit such amount monthly to the Union.

This voluntary authorization and assignment shall be irrevocable, regardless of whether I am or remain a member of the Union, for a period of one year from the date of execution or until the termination date of the collective-bargaining agreement (if there is one) between the Employer and the Union, whichever occurs sooner, and for year to year thereafter unless I give the Employer and the Union written notice of revocation not less than ten (10) days and not more than twenty (20) days before the end of any yearly period. This card supersedes any prior check-off authorization card I signed. 

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. 

Payments to the Union are not deductible as charitable donations for federal income tax purposes. However, state law may extend favored tax treatment.

Signature