Withdrawal Card Request

Online Withdrawal Card Request Form

Advisory on Withdrawal Cards

Members not working at the craft for a complete calendar month for reasons other than sickness or injury may request and be issued an Honorable Withdrawal Card in accordance with Article XVIII of the International Constitution.

Members off work for a complete calendar month because of sickness or injury should fill out the following form for issuance of a withdrawal card.

Please note that any member who is not required to request a withdrawal card in accordance with the International Constitution but who requests and is issued a withdrawal card must be advised that the issuance of that withdrawal card may result in a break in their twenty-four Month continuous standing requirements of eligibility to:

Hold local union office.
Be a delegate/alternate Delegate to the next International Convention
Be a candidate to run for International Union office; and
Nominate/vote in the election of Union officers; the election of Delegates/Alternates; or, in the election of International Union officers
Any other continuous good standing requirements of Local Union No. 177 as stated in the Local Union Bylaws

If you are unsure if you qualify for a Withdrawal Card, or if you are BEHIND ON DUES already, please contact the Union Hall at 973-923-7070 BEFORE filling out this form in its entirety.

* Required fields

Member Information

First Name *	Last Name *
Address *
City *	State *
Zip Code *	Phone *
SSN — Last 4 Digits * XXX-XX-	UPS ID Number If applicable

Leave Information

Reason for Leave *
Last Day Worked *	Estimated Return to Work Date (if applicable)
Additional Comments

Electronic Signature

Electronic Signature — Full Name *

Today's Date *

Signature:

Use your mouse, finger, or touch device to write your signature.

RETURNING TO WORK? YOU MUST CONTACT THE UNION HALL.

It is your responsibility to notify Teamsters Local 177 when you return to work so you can be returned to Active Status.

Call (973) 923-7070

Failure to notify the Union Hall upon your return to work may result in back dues.

By clicking "Submit" and filling out the Electronic Signature box you hereby certify that all information provided as part of this application is true and correct to the best of your knowledge and is being filled out by the named applicant. You therefore also give consent to Teamsters Local Union 177 to use the information provided herein for the purpose of changing from an Active Status to Withdrawal Status.

* Required fields