Local No.4 Check-Off Authorization

Member Information
Format: 123-45-6789
Gender
Marital Status
Employer Information
Authorization
Signature Method *
Type your name as your signature. This keeps the current simple phone-friendly workflow.
Use your finger, mouse, or stylus. The drawn signature is stamped into the generated PDF.

This leaves the signature line blank so the completed PDF can be opened and digitally signed in Adobe Acrobat afterward. This is the closest match to a true Acrobat digital-signature workflow, but it means the PDF is not fully signed at phone submission time.

Additional Authorizations
4.0% Wage Assignment Disclosure *
You must read and accept this disclosure before submitting.

Mandatory Disclosure

Effective immediately, the undersigned assigns to Theatrical Stage Employees, Local No. 4, IATSE, four percent (4.0%) of all wages earned and to be earned by them as an employee, and authorizes and directs their employer to deduct such percentage from their wages and to remit same to the Union. This assignment shall be irrevocable for a period consisting of either one (1) year or until termination of this agreement whichever is sooner, and shall be automatically renewed, with the same irrevocability for successive like periods, unless terminated by the undersigned in writing not more than twenty (20) nor less than ten (10) days prior to the expiration of such periods. Furthermore, the undersigned authorizes and directs their employer to provide Local No. 4, IATSE with any/all employee information they may request.