Rochester School District. Dues Deduction Authorization Form
Rochester School District. Grievance Record Grievance No. Level Date filed: Name of Grievant(s): Building: Assignment: Date of alleged violation(s) or misapplication(s) Article of the Agreement allegedly violated: Statement of the grievance: Nature and extent of the injury or loss involved: Remedy sought: Signature - Federation Representative Signature - Grievant Present Disposition by: Principal Superintendent Date answered: Principal/Superintendent Grievance settled on the basis of Principal's Superintendent's answer: Grievant Appendix E Rochester School District Dues Deduction Authorization Form Name I hereby authorize the Rochester School District to withhold from my salary, Federation dues in an amount to be certified by the Treasurer of the Rochester Federation of Teachers, acknowledging that the amount of dues may increase at times subsequent to the authorization, and this authorization shall be a continuing authorization for such dues deductions. The sums thus to be deducted over the period of one year, (twenty-two pay periods, twenty-six pay periods, or other arrangement as permitted by the Master Agreement) are hereby assigned by me to the Rochester Federation of Teachers, and are to be remitted by the Rochester School Department to the Treasurer of the Federation. Having done so, the District shall be held harmless from any claim(s) in connection with the provisions of this authorization and Master Agreement terms. It is further agreed that the District assumes no financial liability except to forward, on a monthly basis, those funds which have been properly authorized and deducted the last day of the preceding month. This authorization and assignment shall continue in full force and effect from year to year unless I notify the Office of the Superintendent and the Rochester Federation of Teachers’ Treasurer in writing between June 1 and September 1, to cease deductions for the coming year. Signature: Date: Home Address: City: State: Zip: Phone #: ( ) S.S. #: Employee #: _ School: Home E-Mail: Please check position below: Teacher: Para-Professional: Food Service: Recruited By: Once completed, this form must be sent directly to the Federation Treasurer. For Office Use Only: Date Received: Copies sent to: Vice-President Central Office Date: _ Date: _ SIDEBAR A
