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Authorization For Representation

I authorize Local Union Number 177 of the International Brotherhood of Electrical Workers, to represent me in collective bargaining with my employer.
You can type the information into this form. You must print the completed form and sign it. The completed, signed form can then be mailed to the address at the bottom of the page

First name: Last Name:

Street address:

City:

State/Province: Zip/Postal Code:

Phone

E-mail

Employer

Date

Signature

I completed this Authorization Card published on the IBEW177 web site of my own free will. I have read and understand that this is for representation and in no way obligates me to join the Union or pay any dues or fees to this Union. I have completed this authorization freely and voluntarily and not out of any fear of reprisal from the Union. I understand this card may be used as a showing of interest to the National Labor Relations Board in the case of a petition for an election or to demonstrate to my employer a clear majority of employee support in an appropriate bargaining unit in the case of a request for recognition or, if necessary, to support a bargaining order.

Feel free to contact either of our Organizers with any further questions.

Phone-(904)355-4569

Address - 966 Liberty Street, Jacksonville, Florida 32206

Email - organizingdept@ibew177.org

	Authorization For Representation
	I authorize Local Union Number 177 of the International Brotherhood of Electrical Workers, to represent me in collective bargaining with my employer. You can type the information into this form. You must print the completed form and sign it. The completed, signed form can then be mailed to the address at the bottom of the page
	First name: Last Name:
	Street address:
	City:
	State/Province:	Zip/Postal Code:
	Phone
	E-mail
	Employer
	Date
	Signature
	I completed this Authorization Card published on the IBEW177 web site of my own free will. I have read and understand that this is for representation and in no way obligates me to join the Union or pay any dues or fees to this Union. I have completed this authorization freely and voluntarily and not out of any fear of reprisal from the Union. I understand this card may be used as a showing of interest to the National Labor Relations Board in the case of a petition for an election or to demonstrate to my employer a clear majority of employee support in an appropriate bargaining unit in the case of a request for recognition or, if necessary, to support a bargaining order.


	Feel free to contact either of our Organizers with any further questions. Phone-(904)355-4569 Address - 966 Liberty Street, Jacksonville, Florida 32206 Email - organizingdept@ibew177.org