FA Dues Deduction Form – 2016-2017

2016-17   SIUC FA INSTRUCTIONS FOR COMPLETING

PAYROLL DEDUCTION AUTHORIZATION FOR UNION DUES

  1. Enter your AIS (employee) ID number.
  2. Fill in your name.
  3. Enter your address. (For those of you with a post office box number address it is very important that you also list your legal street address.)
  4. Enter the department you work in.
  5. Enter the month/year of the pay period you wish your membership to begin. (Examples: Aug. 2016 (Sept. paycheck); Sept. 2016 (Oct. paycheck):
  6. Sign and date your authorization form.

(Detach and return bottom portion, to J’Neita Fassel, IEA-NEA, 500 E. Plaza Drive, Suite 5, Carterville, IL  62918.  For questions call 1-800-431-3730.  IEA-NEA Enrollment forms will be mailed upon receipt of the Dues Deduction Form.  The IEA-NEA Form will finalize your membership in the SIUC Faculty Association, IEA-NEA and result in the issuance of your IEA-NEA Membership Card.  This card gains you access to the MEMBERS ONLY portion of the IEA-NEA website at www.ieanea.org (including member only discounts).

 

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PAYROLL DEDUCTION AUTHORIZATION

UNION DUES

Southern Illinois University at Carbondale

TO:      Payroll                          I am paid:   ¨ Biweekly      ¨ Semi-monthly     ¨ Monthly

I hereby authorize Southern Illinois University at Carbondale to deduct each month the amount of $67.40 or the amount subsequently certified by the union as the current rate of dues.  The deductions are to be turned over to local: SIUC Faculty Association, IEA/NEA.

Soc. Sec. No.  ________________

Name (Last, middle, first)___________________________________________

Street ___________________________City _______________________

State/Zip __________

SIUC Department: ____________________________________________________

Effective Pay Period: ___________________

Employee Signature and Date:________________________________________

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