Teamsters Local 455

January 22, 2021

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January 2021

IBT Grievance Program - Stewards Only

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Withdrawal Request Form

First name:
Last Name:
Address:
City,State,Zip:
Area Code+Telephone
Last Day Worked-Month,Day,Year
Company Worked For
Last 4 Digits of Social Security Number
Reason for Withdrawal	Termination/Resignation Leave of Absence Workers Comp Disability