PWEA Union Authorization Card

YES, I am standing with my coworkers!

UNION AUTHORIZATION FORM
Name Name * First Last
Personal Cell Phone Personal Cell Phone * - ### - ### ####
Personal Email *

Confirm Personal Email *
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employer *
Job Title *
Employee ID Number *
Work Location *
Work Hours (Ex: 8am-4pm) *
Employee Type *

Employee Type Classified Certified/Licensed
MY PLEDGE: *

MY PLEDGE: I support working together with my colleagues for a voice in decisions that aﬀect our professions and our future. I understand that as employees of Prince William County Public Schools, we now have the opportunity to have a meaningful seat at the table through collective contract negotiations. I authorize Prince William Education Association/Virginia Education Association to represent me in collective bargaining with my employer concerning wages, hours, and other terms and conditions of employment. I understand that this authorization card can be used by Prince William Education Association/Virginia Education Association to obtain certiﬁcation from my employer and/or petition the school board to pass a resolution providing for collective bargaining.
Your Signature *

Draw or Type

I UNDERSTAND THIS IS A LEGAL REPRESENTATION OF MY SIGNATURE. BY CLICKING SUBMIT, I ACCEPT THAT MY PRINTED NAME, THE DATE AND TIME OF SUBMISSION WILL BE USED AS MY DIGITAL SIGNATURE FOR THE PURPOSES OF THIS FORM. Clear

Full Name

I UNDERSTAND THIS IS A LEGAL REPRESENTATION OF MY SIGNATURE. BY CLICKING SUBMIT, I ACCEPT THAT MY PRINTED NAME, THE DATE AND TIME OF SUBMISSION WILL BE USED AS MY DIGITAL SIGNATURE FOR THE PURPOSES OF THIS FORM.

PWEA Union Authorization Card

YES, I am standing with my coworkers!