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IP-35 Lost-Timer Signup
Fill out this form in order to sign up as a "lost-timer" working on the IP-35 signature-gathering campaign.  This information will be shared with third-party contractor Fieldworks as needed.
Personal Information
First Name
Last Name
Worksite (Where you work now)
Email Address
Best Phone Number
Understanding  (You must read and check these  boxes before signing up.)
You will need to provide a 2024 W-4 tax form to UFCW Local 555 if you have not already done so in 2024.  You may upload it here or deliver it to UFCW Local 555, but the Local must have it in hand before you are paid.
If you generate your form online, you will still need to upload the PDF you downloaded.
The online form does not include the optional Page 3 worksheet.  See instructions here.
Upload Form W-4
If you have not already been a lost-timer in 2024, you will also need to provide an I-9 form, along with proof of eligibility to work (typically a Social Security Card or U.S. Birth Certificate) and your identity (typically a Driver License) or both (typically a U.S. Passport.)  By law, we are not permitted to accept these remotely.  You must bring valid identification (usually a Driver License) and proof of eligibility to work (usually a Social Security card or birth certificate) or an ID that fulfills both (usually a U.S. Passport) to your onboarding appointment.  If you worked for UFCW 555 as a lost-timer already in 2024, we already have an I-9 for you and you do not need to do this again!
You can also fill out a Direct Deposit form.  It is optional, but highly recommended.  Instead of uploading this, download it and then email it directly to
Onboarding Appointment
Select from the available times and locations below to schedule your onboarding and training with Fieldworks.
If all of the information is correct, press SUBMIT to be scheduled for the onboarding appointment you selected.  A confirmation e-mail will be sent to your email address and Fieldworks will be informed that you will be attending the appointment you selected.

An error occurred. Try again later

Congratulations!  You have been signed up.  A confirmation email will be sent to ___.  As a reminder, you will be attending the following onboarding appointment: ___
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