UNITED FEDERATION OF SPECIAL POLICE AND
SECURITY OFFICERS, INC
AUTHORIZATION FOR REPRESENTATION
I, the undersigned, designate United Federation of Special Police and Security Officers, Inc., an employee organization, as my sole and exclusive representative for the purpose of negotiating collectively with my employer on my behalf on all matters pertaining to my wages and/or salary, hours, terms and conditions of employment.
NAME (please print) ______________________________________ DATE:____________
ADDRESS ______________________________________________ APT #___________
CITY ___________________________________STATE ______ ZIP ________________
EMPLOYED BY___________________________________________________________
BIRTH DATE___________________ JOB TITLE________________________________
SOCIAL SEC NBR____________________ HOME PHONE NBR (____)_____________
E-mail:________________________________________________________________
EMPLOYEE SIGNATURE____________________________________________________
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