CWA Membership Card

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Payroll No.
Print Employee Name
Social Security Number
AUTHORIZATION FOR EMPLOYEE ORGANIZATION DEDUCTION
hereby authorize the State of New Jersey to make biweekly deductions from my salary in an amount certified to you
by the union The amount deducted shall be paid to the Secretary Treasurer of the Union I understand that the authorization shall remain in effect unless cancelled by me in writing pursuant to the provisions of the negotiated contract
Name_,
Trenton, NJ 08618
Home Address
Zip
City State
Phone
(Home)
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Online Membership Card
Employee
Organization
CWA Local 1033
321 W. State St.
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(Work)
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Home Email Address
Job Classification Title
FOR PAYROLL CLERK USE ONLY
CODE
81-WEEKLY
AMOUNT
Employee Signature
Date
Payroll Clerk Signature
Dept. & Location
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Date
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