AUTHORIZATION FOR REPRESENTATION BY GEICO UNITED, A LABOR UNION

All signatures are completely confidential. Members of management will never see your responses.

Line Agents (Sales, Service, UW, Claims), Supervisors, Trainers, Coaches, Adjusters, Attorneys, MDPs, Mailroom Associates and IT Staff are Encouraged to Sign.

*1.Please provide your personal contact information. Do not include your work email or work address in this section.(Required.)

First Name

Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Job Title

Email Address

Phone Number

*2.Next you must include your employer's name and address. Please type the address of the GEICO regional office in which you are employed.(Required.)

Company

Address

City/Town

State/Province

ZIP/Postal Code

*3.I, the undersigned employee of GEICO, authorize GEICO United, a labor union, to represent me for the purposes of collective bargaining. Please type your first and last name in the space below.(Required.)

*4.Would you like to be part of the organizing committee? This would include being known publicly as an organizer.(Required.)

*5.How did you hear about us?(Required.)

My manager/supervisor told me about the union

Word of mouth from another co-worker

I spoke to an organizer during a house visit

Someone left a flyer at my door

I saw a sign/pamphlet in the physical office

Instagram

Facebook

Youtube

Twitter

Other (please specify)

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