Home "*" indicates required fields Step 1 of 6 16% This field is hidden when viewing the formToday's Date* MM slash DD slash YYYY FEDEMPLOYEE-ID-Become an IAM Represented Federal Employee Today by Filling Out the Form Below! Welcome. You are completing the IAM's official membership application as well as the required witholding authorization for federal payroll processors. Your information will be collected, documents created and sent to the appropraite individuals and to you with the email you provide. --United States Code Notification-- Section 5525 of Title 5 United States Code (Allotments and Assignments of Pay) permits Federal agencies to collect this information. This completed form is used to request that labor organization dues be deducted from your pay and to notify your labor organization of the deduction. Completing this form is voluntary, but it may not be processed if all requested information is not provided. This record may be disclosed outside your agency to: 1) the Department of the Treasury to make proper financial adjustments; 2) a Congressional office if you make an inquiry to that office related to this record; 3) a court or an appropriate Government agency if the Government is party to a legal suit; 4) an appropriate law enforcement agency if we become aware of a legal violation; 5) an organization which is a designated collection agent of a particular labor organization; and 6) other Federal agencies for management, statistical and other official functions (without your personal identification). Executive Order 9397 allows Federal agencies to use the social security number (SSN) as an individual identifier to avoid confusion caused by employees with the same or similar names. Supplying your SSN is voluntary, but failure to provide it, when it is used as the employee identification number, may mean that payroll deductions cannot be processed. Your agency shall provide an additional statement if it uses the information furnished on this form for purposes other than those mentioned above. Verification* Yes I am a Federal Employee Before you proceed you must check to verify that you ARE in fact a Federal Employee. Personal InformationFirst Name*Middle NameLast Name*Date of Birth* MM slash DD slash YYYY Gender--- Please Select ---FemaleMaleOtherGender OtherPersonal Email Enter Email Confirm Email IAM Emails Check here to OPT - OUT of receiving emails from the IAM. Personal Mobile Phone NumberHome Address*(Street Number, City, State and ZIP Code) Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Employer InformationYour EmployerEmployee Identification Number*Employee or Last 4 of SSNEmployer Phone*Hire Date MM slash DD slash YYYY Class of WorkYear's ExperienceWork Shift First Shift Second Shift Third shift Local Lodge & Dues InformationYour Local & District Lodge* District160 Local Agency Local 282 Pay / Dues / Agency Code* Rate of Pay$17.60 and below$17.61 to $18.00$18.01 to $18.50$18.51 to $19.00$19.01 to $19.50$19.51 to $19.50$20.01 to $20.50$20.51 to $21.00$21.01 to $21.50$21.51 to $22.00$22.01 to $22.50$22.51 to $23.00$23.01 to $23.50$23.51 to $24.00$24.01 to $24.50$24.51 to $25.00$25.01 to $25.50$25.51 to $26.00$26.01 to $26.50$26.51 to $27.00$27.01 to $27.50$27.51 to $28.00$28.01 to $28.50$28.51 to $29.00$29.01 to $29.50$29.51 and $30.00$30.01 to $30.50$30.51 to $31.00$31.01 to $31.50$31.51 to $32.00$32.01 to $32.50$32.51 to $33.00$33.01 to $33.50$33.51 to $34.00$34.01 to $34.50$34.51 to $35.00$35.01 to $35.50$35.51 to $36.00$36.01 to $36.50$36.51 to $37.00$37.01 to $37.50$37.51 to $38.00$38.01 to $38.50$38.51 to $39.00$39.01 to $39.50$39.51 to $40.00$40.01 to $40.50$40.51 to $41.00$41.01 to $41.50$41.51 to $42.00$42.01 to $42.50$42.51 and $43.00$43.01 to $43.50$43.51 to $44.00$44.01 to $44.50$44.51 to $45.00$45.01 to $45.50$45.51 to $46.00$46.01 to $46.50$46.51 to $47.00$47.01 to $47.50$47.51 to $48.00$48.01 to $48.50$48.51 to $49.00$49.01 to $49.50$49.51 to $50.00$50.01 to $50.50$50.51 to $51.00$51.01 to $51.50$51.51 to $52.00$52.01 to $52.50$52.51 to $53.00$53.01 to $53.50$53.51 to $54.00$54.01 to $54.50$54.51 to $55.00$55.01 to $55.50$55.51 and $56.00$56.01 to $56.50$56.51 to $57.00$57.01 to $57.50$57.51 to $58.00$58.01 to $58.50$58.51 to $59.00$59.01 to $59.50$59.51 to $60.00$60.01 to $60.50$60.51 to $61.00$61.01 to $61.50$61.51 to $62.00$62.01 to $62.50$62.51 to $63.00$63.01 to $63.50$63.51 to $64.00$64.01 to $64.50$64.51 to $65.00$65.01 to $65.50$65.51 to $66.00$66.01 to $66.50$66.51 to $67.00$67.01 to $67.50$67.51 to $68.00$68.01 to $68.50$68.51 to $69.00 Bi-Weekly Dues Agency Code You must make a selection for all fields. If you only have one option you must select it to continue.Local 297 Pay / Dues / Agency Code* Rate of Pay$17.60 and below$17.61 to $18.00$18.01 to $18.50$18.51 to $19.00$19.01 to $19.50$19.51 to $20.00$20.01 to $20.50$20.51 to $21.00$21.01 to $21.50$21.51 to $22.00$22.01 to $22.50$22.51 to $23.00$23.01 to $23.50$23.51 to $24.00$24.01 to $24.50$24.51 to $25.00$25.01 to $25.50$25.51 to $26.00$26.01 to $26.50$26.51 to $27.00$27.01 to $27.50$27.51 to $28.00$28.01 to $28.50$28.51 to $29.00$29.01 to $29.50$29.51 to $30.00$43.01 to $43.50$43.51 to $44.00$44.01 to $44.50$44.51 to $45.00$45.01 to $45.50$45.51 to $46.00$46.01 to $46.50$46.51 to $47.00$47.01 to $47.50$47.51 to $48.00$48.01 to $48.50$48.51 to $49.00$49.01 to $49.50$49.51 to $50.00$50.01 to $50.50$50.51 to $51.00$51.01 to $51.50$51.51 to $52.00$52.01 to $52.50$52.51 to $53.00$53.01 to $53.50$53.51 to $54.00$54.01 to $54.50$54.51 to $55.00$55.01 to $55.50$55.51 to $56.00 Bi-Weekly Dues Agency Code You must make a selection for all fields. If you only have one option you must select it to continue. Check Off & Other AuthorizationsIAM Membership Application* Authorized To the Officers and Members of Lodge No. {Field:34:value} (the "Lodge" or "Union"), I hereby tender my application for membership in the International Association of Machinists and Aerospace Workers (IAM). I understand that while I may be required to tender monthly fees to the Union, I am not required to apply for membership or be a member as a condition of employment and that this application for membership is voluntary. As a member, I agree to obey the Constitution of the IAM and the by laws of my Lodge and to support the principles of trade unionism, and I authorize the IAM and/or its designated affiliate to act as my representative for collective bargaining.Dues or Fees Check Off Authorization* Authorized I knowingly and voluntarily consent to and authorize my Employer to deduct from my wages and forward to the Union: (1) monthly membership dues or an equivalent service fee; and (2) any required initiation or reinstatement fee as set forth in the collective bargaining agreement between the Employer and the Union and the by laws of the Lodge. I give this consent regardless of whether I am required to pay dues or fees as a condition of my employment under the law. This authorization shall be irrevocable for one (1) year or until the termination of the collective bargaining agreement between my Employer and the Union, whichever occurs sooner. I agree that this authorization shall be automatically renewed for successive one (1) year periods or until the termination of the collective bargaining agreement, whichever is the lesser, unless I revoke it by giving written notice to my Employer and Union (a) not more than twenty (20) and not less than five (5) days prior to the expiration of the appropriate yearly period or (b) after the contract expiration. I expressly agree that this authorization is independent of, and not a quid pro quo, for union membership, but recognizes the value of the services provided to me by the Union. It shall continue in full force and effect even if I resign my Union membership, except if properly revoked in the manner prescribed above.Former IAM Member?* YES NO Card Number:Last Dues Paid:Lodge Number:Location:MNPL Contribution and Check Off Authorization Auhtorization I knowingly and voluntarily consent to and authorize my Employer to deduct from my wages and forward to the Union the following contribution to the Machinists Non-Partisan Political League, IAM’s organization to make contributions and expenditures in connection with Federal, State, and Local Elections. I understand that I have a right to refuse to give without reprisal. I wish to contribute:MNPL Contribution Amount $5.00 per month $10.00 per month $20.00 per month Do you wish to contribute a different amount to MNPL? YES MNPL Other Amount Notices & IAM Security ClauseImportant Notice* I have examined I have examined and acknowledge receipt of the attached "Notice to Employees Subject to Union Security Clauses" (on back of pink sheet). I also understand that IAM members have certain rights and privileges as set forth in the IAM Constitution and in various Federal laws, like the Labor Management Reporting and Disclosure Act (LMRDA). Copies of the IAM Constitution and the LMRDA may be obtained by contacting the IAM General Secretary -Treasurer, 9000 Machinists Place, Upper Marlboro, MD 20772. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code.1187 Authorization by Employee* I agree to the following provisions I hereby authorize the above named agency to deduct from my pay each pay period, or the first full pay period of each month, the amount certified above as the regular dues of the (Name of Labor Organization): MACHINISTS UNION and to remit such amount to that labor organization in accordance with its arrangements with my employing agency. I further authorize any change in the amount to be deducted which is certified by the above named labor organization as a uniform change in its dues structure. I understand that this authorization, if for a biweekly deduction, will become effective the pay period following its receipt in the payroll office of my employing agency. I further understand that Standard Form 1188, Cancellation of Payroll Deductions for Labor Organization Dues, is available from my employing agency, and that I may cancel this authorization by filing Standard Form 1188 or other written cancellation request with the payroll office of my employing agency. Such cancellation will not be effective, however, until the first full pay period which begins on or after the next established cancellation date of the calendar year after the cancellation is received in the payroll office. Contributions or gifts (including dues) to the labor organization shown at left are not tax deductible as charitable contributions. However, they may be tax deductible under other provisions of the Internal Revenue Code.Signature*Human VerificationNameThis field is for validation purposes and should be left unchanged.
