First Name:_________________________ Last Name:___________________________

Address 1:________________________________________________________________  

City: ______________________________________ State: ________Zip:_____________

Phone: ( ______ ) _______ - _________ Cell Phone: ( ______ ) _______ - _________

Employer:_________________________________________ Date of hire: _____________

Work Address: ______________________________________________________________

City: _____________________________ State: _______ Zip:______________

Type of Work / Industry: __________________________________________________________

New member       Check Box
Current member  Check Box & Union Book Number: ____________
                                                   
Send this form by postal mail or fax to Mechanics Local 701:

Automobile Mechanics Local 701
500 West Plainfield Rd.
Countryside, IL 60525

To contact Local 701 call:  (708) 482-1720

Note to employers:
This form may be used to report new employees to Local 701.