UNITED FOOD & COMMERCIAL WORKERS
LOCAL 791
AUTHORIZATION FOR REPRESENTATION
I hereby authorize the United Food
and Commercial Workers Union, Local 791
to represent me for the purposes of collective bargaining.
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PRINT
NAME
SOCIAL SECURITY # OR SSI
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SIGNATURE
DATE
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HOME
ADDRESS
CITY
STATE ZIP
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E-MAIL ADDRESS
HOME PHONE
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EMPLOYER'S
NAME
EMPLOYER'S ADDRESS
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HIRE DATE
TYPE OF WORK PERFORMED DEPARTMENT
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HOURLY
RATE DAY OFF SHIFT/HOURS
FULL-TIME PART-TIME (CIRCLE ONE)
WOULD YOU PARTICIPATE IN AN ORGANIZING COMMITTEE? YES NO (CIRCLE ONE)
UFCW Local 791,
1-800 535-2752