Upon taking this
Withdrawal Card, I do hereby certify under penalty of perjury that I
have no pending claims under the Grievance Procedure of my Collective
Bargaining Agreement and that I further have no claims to be asserted
under the Grievance Procedure of my Collective Bargaining Agreement.
Your Email Address (username@server.com)
Last Name
First Name
Last Four (4) Digits of Your
Social Security Number
Employer
Job Classification
Daytime
Telephone
Evening
Telephone
Street Address (123 StreetName)
City, State & Zip Code
Enter the LAST day you worked
Enter as 00/00/00):
Click the Reason for Withdrawal:
Disability
Terminated
Resigned
Changed
to a Non-Union Position
Other
To be eligible
for a withdrawal card, your initiation fees must be paid and your
monthly dues must be current. Are your dues current and
initiation/transfer fees paid? YES
It is your
responsibility to notify the Union immediately upon your return to a
Teamster capacity. Click here
to indicate you understand your responsibility:
Please Print and Send Form to:
Teamsters Local No. 439
P.O. Box 1611
Stockton, CA 95201-1611