Burlington Northern System Federation

BNSF New Hire Application

WAGE ASSIGNMENT AUTHORIZATION & ENROLLMENT FORM
BROTHERHOOD OF MAINTENANCE OF WAY EMPLOYES DIVISION – IBT

TO BNSF RAILWAY

I hereby assign to the Brotherhood of Maintenance of Way Employes Division (BMWED) that part of my wages necessary to pay my monthly union dues (not including fines and penalties) as reported to the BNSF Railway by the appropriate General Chairperson of the BMWED System Division or System Federation to which I am assigned. Such reports will be made in the form agreed upon between the parties and as provided in the Dues Deduction Agreement entered into between BNSF Railway and its employees represented by the BMWED effective January 1, 1980.

I hereby authorize BNSF Railway to deduct from my wages all such sums and remit them to the BMWED National Division Secretary Treasurer in accordance with the said Dues Deduction Agreement.

This authorization may be revoked by the undersigned at any time after the expiration of one year from the date of its execution, or upon the termination of said Dues Deduction Agreement, or upon the termination of the Rules and Working Conditions Agreement between BNSF Railway and BMWED, whichever occurs sooner.

Dues contributions or gifts to the BMWED are not deductible as charitable contributions for federal income tax purposes. Dues paid to the BMWED, however, may qualify as business expenses and may be deductible in limited circumstances, subject to various restrictions imposed by the Internal Revenue Code.

I, the undersigned:

Apply for membership in the Brotherhood of Maintenance of Way Employes Division—IBT, and agree to abide by its Constitution and Bylaws;
Authorize this Union to be my exclusive bargaining agent.

Birth Date:	mm/dd/yy
Preferred Greeting:	Brother Sister
First Name:
Middle Initial:
Last Name:
Social Security Number:	- -
Mailing Address Line 1:
Mailing Address Line 2:
City:
State:
Zip:
Cell Number:
Cell Provider:
Personal Email Address:
Employee ID Number (7 digits):	7 digits; no letters
Service Entry Date:	mm/dd/yy
District:	100, 200, 300, or 1000 [MRL]
Hire Location:
Occupation:
Are You A Previous Member of BMWED or other IBT (Teamsters) Affiliated Railroad Union?	Yes No
If yes, list Craft/Union:
If yes, list Railroad:
Are you a Veteran?	Yes No
If yes, what branch?
Todays Date:	mm/dd/yy
Signature:	Signature: Use your mouse, finger, or touch device to write your signature.