Ontario Public Service Employees Union
Membership Application Form
Ontario Public Service Employees Union, 100 Lesmill Road, Toronto, Ontario M3B 3P8
1-800-268-7376 / www.opseu.org
Form 101 February 1, 2018
First name
Initials Last name
Employee # (if available)
Union # (if available)
Date of birth (mm/dd/yyyy)
Female Male Prefer to self-describe
Home address: (Unit/Apt.)
Street:
City:
Province: Postal code:
Home phone:
Work phone: ext:
Cellular:
Secure (non-work) email:
Employer:
Store #: (LBED only)
Work address:
Ministry (OPS only):
Job classification/Job title:
Date of hire: (mm/dd/yyyy)
BPS
Full-time
Reg. Part-time
Relief/Casual
CAAT-A
Full-time
Partial Load
CAAT-S
Full-time
Appendix D
Appendix G
Part-time
Regular
Student
OPS
Full-time
Reg. Part-time
Student
Fixed Term
Flexible Part-time
While OPSEU does not sell or otherwise provide personal information to third parties, the union periodically provides
information to members about union approved group affinity programs (ie. cell phones, home/auto insurance etc.). In
accordance with the Privacy Act, if you do not wish to receive this type of information, please mark box below:
I do not wish to receive group affinity program information.
I hereby request and accept membership in the Ontario Public Service Employees Union. I authorize OPSEU to act as
my exclusive bargaining agent in all matters pertaining to my employment relationship with my employer. I solemnly
promise to uphold and obey the Constitution and By-laws of this Union, to assist my fellow members to improve their
economic, political and social conditions, to uphold the principles of democracy and fair play, and to do no deliberate
wrong or harm to any member of this Union.
Signature of Applicant
Date (mm/dd/yyyy) Local #
Recruiter's name (please print)
Recruiter's signature
Business phone
On behalf of OPSEU, I hereby accept this application.
For Office Use Only:
Date _______________ Clerk____________
❑ Paying New Members ❑ Unclassified
❑ Duplicate ❑ Re-instated
❑ Being organized ❑ Addition
❑ Local change only ❑ Second job
❑ Address change only
❑ Name changed from: __________________________
Complete form, print and sign where required. Forward to your OPSEU
Regional Office.
Detach this portion and give to applicant
Ontario Public Service Employees Union
Temporary Card
This certifies that
(Print Name) is a member of the above-mentioned union.
Member's Signature
Date mm/dd/yyyy
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
