Teamsters Local #252--Withdrawal Request

Withdrawal Request

If you are no longer working in Teamster employment and would like to be placed on withdrawal, please complete and submit the following form. Or you may print this page, fill it out and then mail it to:

Withdrawal Request
Teamsters Local #252
217 E. Main Street
Centralia, WA 98531-4449

Upon receipt of your request, you will be placed on withdrawal in the Teamster Titan Computer System. If you wish an actual withdrawal card to be issued to you, please check the appropriate box.

Please complete ALL fields.

Date of request:

Name:

Last 4 digits of Social Security Number:

City:

State: ZIP:

I, , am requesting an honorable withdrawal card from Teamsters Local Union #252 for the following reason:

I have terminated I was laid off

I am on leave of absence I am on medical leave

Other -- explain:

Employer:

Last day worked: (Month/Day/Year)

I wish to have a Withdrawal Card sent to the address I have provided above.