All Union - UNION TIME COMPENSATION FORM

Union Time Compensation Form

Updated Feb 2026
This form is to record time you worked on union activities at the request of the union. Do not enter any time for which you were being paid by your employer as vacation, sick time or any other form of compensation.

IMPORTANT NOTICE: You will be redirected to fill out a W-4 form after you hit Submit. This form MUST be completed, as a payroll check cannot be processed if there is an incomplete or blank W-4 form. Wages claimed on this form are subject to payroll taxes.

If you have questions or need help, please ask a union organizer.
Contact Information
Legal Name*

Legal First NameLegal Last Name
Cell phone*
Personal Email*
Mailing Address*

Street Address

Apt #, Suite #, etc (optional)

CityState

Zip Code
Is this a new address?

Check here if yes
Birth date
Month/Day/Year
Employer*
Tax filing status
Union Time Information
Reason for Union Time*

Bargaining/NegotiationsOrganizing CampaignE-BoardSteward/Member TrainingPolitical Campaign/TrainingGreen Janitor TrainingOther
Requested by: (Union staff name)*
Hourly rate of pay*
Total amount to pay (hourly rate X number of hours)*
Date (s) and Hour (s)*
Total number of hours
Optional: Direct Deposit

For direct deposit, please complete the following. Otherwise a paper check will be mailed to the address provided.
Bank name
Routing number
Account number
Signature*

Clear
Today's date*

MonthDayYear
Date
IMPORTANT NOTICE: After you hit “Submit,” you will be redirected to fill out a W-4 form. SEIU 49 MUST have a current W-4 form on file to pay you for your time.
A check cannot be issued to you if your form is incomplete, lacks your current information, or if it is blank. Wages claimed on this form are subject to payroll taxes.
DESCRIPTION OF UNION ACTIVITY*
Should be Empty:

Union Time Compensation Form

Contact Information

Union Time Information

Optional: Direct Deposit