Forms

Membership Forms

Membership Application

Application for Withdrawal Card

Q: What is a withdrawal card and why is it so important?
A: If a member does not work any days in the bargaining unit during the current calendar month the member shall be issued an honorable withdrawal card upon request. All financial obligations including dues must be paid current at the time of the request. It is very important to request a withdrawal card in a timely manner as dues can accrue until a withdrawal card is requested. Upon returning to bargaining unit work, you, are required to contact the Local Union immediately to deposit your withdrawal card and return to “active” member status.

Q: What happens if I don’t request an honorable withdrawal card?
A: If a member does not request a withdrawal card, he/she shall stand suspended at the end of the third month, and shall not be entitled to any rights or privileges of membership. Upon returning to employment at the craft a re-initiation fee plus back dues will be required for entitlement to the rights and privileges of membership. 

Life with Dues Beneficiary Form

Update Personal Information with Local 222 – This form will only update your information at the Local Union Hall. If you need to update information with your insurance and/or pension that must be done separately.

Grievance Forms

Grievance Form – For members working at ABF, American Airlines, DHL, MV Transportation, NCS-EML, Rail Terminal Services, Reddaway, or YRC

Grievance Form for Members Represented by Marty Cowin – For members working at Albertsons, ALSCO, Bimbo Bakeries, Dairy Farmers of America, Gold Cross Ambulance, Innovated Consulting & Management Services , Magna Water, MTC, Ryder, or Univar

Grievance Form for Members Represented by Grant Edwards – For members working at Forterra, Geneva Rock, Granite Construction, Hertz, Praxair, or W.W. Clyde

UPS Grievance Form

UPS 9.5 Grievance Form

Insurance Forms

Utah Idaho Teamsters/Southwest Service Administrators Enrollment Form

Utah Idaho Teamsters/Southwest Service Administrators Retiree Enrollment Form – Direct Payment Authorization Form HERE

Utah Idaho Teamsters/Southwest Service Administrators Short Term Disability Form

Utah Idaho Teamsters/Southwest Service Administrators Change of Address Form

Utah Idaho Teamsters/Southwest Service Administrators Change of Address – The most efficient way to update your address with the insurance is to log in to your ssaportal at www.ssatpa.com.

Log into ssaportal and click on the “My Account” application then click on the the “Change Address” button. Click on Apps. Select change address. Select update my information & enter current info. Make sure to select update.

Utah Idaho Teamsters/Southwest Service Administrators HRA Claim Form – Q&A HERE

Teamsters Western Region & Local 177 Health Care Plan Enrollment Form

Teamsters Western Region & Local 177 Retiree Enrollment Form – Direct Payment Authorization Form HERE

Teamsters Western Region & Local 177 Short Term Disability Form

Teamsters Western Region & Local 177 Change of Address Form

Western Teamsters Welfare Trust Enrollment Packet

Western Teamsters Welfare Trust Retiree Enrollment Form

Western Teamsters Welfare Trust Disability Form

Pension Forms

Western Conference of Teamsters Pension Beneficiary Designation Form (English)

Western Conference of Teamsters Pension Beneficiary Designation Form (Spanish)

Retired Western Conference of Teamsters Pension Beneficiary Designation Form (English)

Western Conference of Teamsters Pension Change of Address Form

Hiring Hall Forms

Construction Registration Form

Movies Registration Form