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Fairfax Co. Federation of Teachers Member Application
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First Name
*
Middle Name
Last Name
*
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Mailing Country
*
United States of America
Mailing Address
*
Mailing Suite
Mailing City
*
Mailing State
*
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Mailing Zip Code
*
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Home Phone
Mobile Phone
Preferred Phones
preferred
preferred
Personal E-mail
*
Work E-mail
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Employee ID
*
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School
*
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Referral or Recruiter Name
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Job Classification
*
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T-Shirt Size
T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
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Select your membership category
Select your membership category
Teacher Scale
Schedules B & C (non-supervisory employees)
Schedule A employees with salary $50,000+
Classroom Instructional Support
Schedule H (may be deducted biweekly)
Schedule A employees with salary < $50,000
All Part-Time and Hourly Employees (may be deducted biweekly)
Part Time - Teacher Scale Salary <$50,000
Part Time - Teacher Scale Salary >$50,000
Dues Amount
$0.00
Total
* draft
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Authorize
I hereby apply for membership in the FCFT.
I authorize FCPS to withhold from my salary a sum equal to the constitutional monthly dues of the Federation. This authorization may be revoked by me in any month by written notice to FCFT. I will be responsible to notify FCFT, in writing of any change in my job status with FCPS. FCFT will not refund any dues paid without written notice and approval by FCFT. Dues paid to employee organizations may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense.
Print your name
Date
Date
E.g., 2024-10-11
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Math question
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