KCDOA Membership Application Print Name*Mailing Address* Street Address City ZIP / Postal Code Email Address* Phone*Date of Hire* MM slash DD slash YYYY Date of Birth* MM slash DD slash YYYY Work Location (Facility)*Shift*County Employee ID Number* (999-xx-xxxx from SheriffNet & pay stub - NOT CAD ID#)Employee Signature*Date* MM slash DD slash YYYY Initials*I authorize KCDOA to deduct from my pay, the amount of my dues and any other payroll deductions that I have authorizedInitials*I agree to pay dues in accordance with the schedule adopted by the KCDOA Board of Directors.Initials*I wish to have KCDOA and/or their affiliated organizations represent me in all matters within their legal scope of representation. Initials* If I separate from the Detentions Deputy classification for any reason, it is my responsibility to notify KCDOA to stop my dues.Initials*KCDOA will only refund up to (2) two pay periods after separation from the Detentions Deputy classification.OFFICE USE ONLYThis field is hidden when viewing the formReceived by:*This field is hidden when viewing the formDate Received:* MM slash DD slash YYYY This field is hidden when viewing the formAuditor system access by:*This field is hidden when viewing the formAuditor system access date:* MM slash DD slash YYYY This field is hidden when viewing the formFOP web site:*CommentsThis field is for validation purposes and should be left unchanged. Δ