Application Form

Personal Details

GTC Number Title Please select Mr Miss Mrs Ms Dr Forename Surname Date of Birth Teachers Ref Number Home Address Town/City County Postcode Home telephone Mobile Telephone C2K Email address Personal Email Address

Personal History

College/University at which trained Have you previously been a member of the Ulster Teachers' Union? Please select Student Full No Please give previous name if relevant Date of completion of College/university course Present Employment Status Please select Teaching Permanent Teaching Temporary Teaching Part Time Unemployed

 

 

Teachers in Permanent Employment

School School Roll Number (if known) School Postcode Position

If Temporary/Subbing please put Temporary in the "School" and "School Address" section.

Authorisation Deduction

In accordance with the Trade Union and Labour Relations (NI) Order 1995, I authorise you to deduct from my salary, until further notice I hereby authorise the Department of Education and Skills to deduct from my salary, until further notice from UTU Headquarters (see Rule 74), the appropriate subscription to be paid to the UTU on my behalf, the amount of subscription to be determined from time to time in accordance with the UTU Rules. *

Please keep us informed if you move to another school.

DISCLAIMER "Any omission or inaccuracy in the particulars furnished on this form may, at the discretion of the Executive of the Union invalidate an application for membership and any grant of membership made in reliance thereon."

I authorise the Department of Education and Skills to deduct the appropriate subscription from my salary to be paid to the UTU

Full Name Teachers Reference Number

Confirmation

I confirm that the above details are correct and I wish to join the Ulster Teachers' Union subject to the Rules and Constitutions of the Organisation. I hereby undertake, if accepted as a member, to abide loyally by the Rules of the Organisation and to use my best endeavours to promote its objectives and interests.

I have read and understood the UTU Rules and Constitutions