Pacific Northwest Newspaper Guild
Secure Signature Portal
Idaho Statesman
To: The Idaho Statesman
I hereby assign to the Pacific Northwest Newspaper Guild, TNG-CWA 37082, and authorize the Employer to deduct weekly from any salary earned or to be earned by me as an employee, an amount equal to Guild initiation fees, dues and assessments as certified by the Treasurer of the Guild starting in the first week in the month following the date of this assignment. I further authorize and request the Employer to remit the amount deducted to the Pacific Northwest Newspaper Guild, TNG-CWA 37082, no later than the 10th day of each month.
This assignment and authorization shall remain in effect until revoked by me, but shall be irrevocable for a period of one year from the date appearing below or until the termination of the contract between yourself and the Guild, whichever occurs sooner. I further agree and direct that this assignment and authorization shall be continued automatically and shall be irrevocable for successive periods of one year each or for the period of each succeeding applicable contract between the Employer and the Guild, whichever period shall be shorter, unless written notice of its revocation is given by me to the Employer and to the Guild by registered mail not more than thirty (30) days and not less than fifteen (15) days prior to the expiration of each period of one year, or of each applicable contract between the Employer and the Guild, whichever occurs sooner. Such notice of revocation shall become effective for the calendar month following the calendar month in which the Employer receives it.
This assignment and authorization is voluntarily made in order to pay my equal share of the Guild'ss costs of operation and is not conditioned on my present or future membership in the Guild.
This assignment and authorization supersedes all previous assignments and authorizations heretofore given by me in relation to Guild initiation fees, dues and assessments.
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Phone
(Required)
Gender
(Required)
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond
Home Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Employer
(Required)
Date of Hire
(Required)
Month
Day
Year
Work Phone
(Required)
Department in Which Employed
(Required)
Job Title
(Required)
Membership Agreement
Designation Agreement
(Required)
I designate Pacific Northwest Newspaper Guild, Local 37082 as my collective bargaining representative, and to represent me before any Board, Court, Committee or other tribunal in any matter involving collective bargaining. I authorize Pacific Northwest Newspaper Guild, Local 37082 to represent me in adjusting any grievances I may have in connection with my employment.
Authorization
(Required)
I have read and agree to the terms and conditions, confirm the accuracy of the information provided, and consent to the processing of my data for the purpose stated. By checking this box, I acknowledge that I am the person completing and signing this form.
Signature
(Required)
Today's Date
(Required)
Email
This field is for validation purposes and should be left unchanged.
