REPRESENTATION AUTHORITZATION AND REQUEST FOR 
AN EMPLOYEES' ELECTION UNDER THE STATE 
EMPLOYMENT RELATIONS BOARD

I AM AN EMPLOYEE OF _______________________

Job Classification ________________________

Dept.  _______________

Shift  _______________

HOME ADDRESS  _____________________________

CITY  _____________________________________

ZIP CODE  ________________________

Home Phone (______)_______________

I Authorize TEAMSTERS LOCAL UNION NO. 413, affiliated 
with the International Brotherhood of Teamsters, to 
represent me in negotiations for better wages, hours 
and working conditions.

BE SURE YOU DATE AND SIGN THIS CARD     

Signature  ________________________________

PRINT NAME HERE ___________________________

Date  _____________________________________