CONSTRUCTION WORKERS UNION (CLAC) LOCAL No.

63

DISPATCH AGREEMENT
I,
(Please Print Name)

(
(Date of Birth) M/D/Y

), recognize

Construction Workers Union (CLAC) Local No. 63 as my bargaining agent, and agree that CLAC Local No. 63 may represent my employment interests. I acknowledge that by signing this form I am expressing my support for CLAC Local No. 63, and that CLAC Local No.63 may dispatch me to work for CLAC signatory Employers. I agree to abide by the terms and conditions of any collective agreements between CLAC signatory Employers and CLAC Local No. 63. I also agree to allow the Employer to deduct applicable union dues and fees as required and remit the same to CLAC Local No. 63. I further acknowledge that CLAC Local No.63 may keep this form on file, and agree it will remain valid until such time as CLAC Local No. 63 receives from me in writing a request that it be declared null and void. I understand that this dispatch form does not indicate that an Employers hiring requirements have been met.

X________________________________ Applicant Signature

__________________________________ Secretary/Representative

X________________________________ DATE SIGNED