SEIU Local 20152023 Convention Delegate Application "*" indicates required fields Our 2023 Convention will bring together 1,500 SEIU Local 2015 leaders and activists from across California. It will be a powerful and engaging event where we reflect and celebrate our individual and collective accomplishments, discuss the work we still have left to do, and build a unified vision to bring back to our facilities and communities. This application acknowledges that you are interested in attending as a delegate. Please fill out the information below and submit it back no later than August 31st to be considered. Everyone will be notified by September 30th about the status of their application. Apply now to for you opportunity to be considered as a convention delegate. Space is limited. Below please find the minimum criteria required to be considered as a delegate for the SEIU 2015 Convention and initial each area indicated to acknowledge that you meet the criteria: I have signed and submitted a membership card by August 31st.* Yes No As an asscociate member, displaced member of workers without a first contract I am applying to attend as a guest.* Yes I have demonstrated my commitment to building my union by completing required volunteer activities* by August 31st.* Yes I share the vision of the SEIU 2015; I demonstrate our core values; and I hold myself and others accountable to the mission, vision, values and goals of the local.* Yes I submitted a complete application by August 31st, 2023 which includes member sponsors from at least 3 SEIU 2015 members* Yes First Name* Last Name* Region*Select your regionRegion 1Region 2Region 3Region 4Region 5Region 6County*Select your countyAlamedaColusaContra CostaDel NorteFresnoGlennHumboldtLakeLassenLos AngelesMarinMendocinoModocMontereyNapaSacramentoSan BernardinoSan BonitoSan FranciscoSan JoaquinSan MateoSanta ClaraSanta CruzShastaSiskiyouSolanoSonomaTehamaTulareVenturaYoloYubaEmployer (Private Sector ONLY) Phone* Email* Street Address* Street Address Line 2 City* Zip Code* How have you made a difference in your union by volunteering?*Local 2015’s Core Values are leadership, empowerment, excellence, transparency, accountability and compassion. When have you upheld one of these values as a member and leader in the union, please give an example:*How do you plan to share information that you learn at the convention with your fellow Local 2015 Brothers and Sisters and inspire them to be active in their union?*SEIU 2015 Member Supporters Please fill out the information below for three SEIU 2015 members (who have signed membership cards) who endorse your application as delegate for the 2023 Convention.First Member SupporterName* Rolodex ID Phone* Employer/County* Second Member SupporterName* Rolodex ID Phone* Employer/County* Third Member SupporterName* Rolodex ID Phone* Employer/County* *Volunteer activities: qualifying activities include any unpaid volunteer activities that help advance the Justice for All priorities and build the union. The below are all excluded activities for requirement of volunteer hours to union activities for the 2023 convention: Attendance at meetings and events (ex. chapter meetings, coffees, regional meetings, listening tour, orientation, TTH, calls, etc.) Attendance at basic trainings (ex. timesheet trainings, Electronic timesheet trainings, EVV trainings, etc.) Activity done on paid time (ex. internships, lost-time, etc) PhoneThis field is for validation purposes and should be left unchanged.