UNITED FEDERATION OF SPECIAL POLICE
AND SECURITY OFFICERS, INC.
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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