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UNITED FEDERATION OF SPECIAL POLICE

AND SECURITY OFFICERS, INC.

 
540 North State Road
 
Briarcliff Manor, New York 10510

MAINTENANCE FEE DEDUCTION AUTHORIZATION

Date: __________________

To(Security Employer): _____________________________________

I have elected to not join the union. You are authorized and directed to deduct from my wages or salary, as required by the collective bargaining agreement, my contract maintenance fee and to remit same to the United Federation of Security Officers, Inc. This authorization is a voluntary act on my part and shall be irrevocable for a period of one year or until the termination of the collective bargaining agreement, whichever is sooner, and shall, however, renew itself from year to year unless the undersigned gives written notice to the United Federation of Security Officers, Inc.

Signature: _________________________________________________

Print the following information:

Name: _____________________________ Employee Nbr:__________

Address: ________________________________________ Apt:_____

___________________________________________________________

City: _________________________ State:____ Zip:____________

Social Security Number: ___________________________________

Date of Birth: ________________ Date of Hire: _____________

Job Title/Position ______________________ Full/Part-Time ___

Home Telephone Number: (____)_______________________________

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