"*" indicates required fields Fresno County IHSS Negotiations Survey To win the best possible contract for Homecare Workers in Fresno County, we need everyone to be involved and we need to hear from you about your priorities. Please fill out this survey and turn it in no later than November 15, 2022. Thank you for your participation! If you need this survey in another language, please call our Member Action Center (MAC) at 855-810-2015.First Name* Last Name* Provider ID* Street Address* Email* Home Phone Number* Cell Phone Number* Preferred Language* By including your mobile phone number you are authorizing SEIU Local 2015 and its affiliates, using various automated technologies, to call you and send text alerts to you occasionally. We will never charge you for text message alerts, but carrier message and data rates may apply. Reply STOP to any text from us stop receiving messages or reply HELP for more information.Are you Family or Non-Family Provider?* Family Provider Non-Family Provider Both Family & Non-Family Provider Priorities It’s time to win the raises and contract protections we deserve. We listed a number of important issues below.What is your #1 priority?* Wage Increase Healthcare PPE (Gloves, Masks, etc.) Paid Training Retirement Vision and/or dental benefits Paid Time Off (Vacation/Sick Time) Registry Improvements What is your #2 priority?* Wage Increase Healthcare PPE (Gloves, Masks, etc.) Paid Training Retirement Vision and/or dental benefits Paid Time Off (Vacation/Sick Time) Registry Improvements What is your #3 priority?* Wage Increase Healthcare PPE (Gloves, Masks, etc.) Paid Training Retirement Vision and/or dental benefits Paid Time Off (Vacation/Sick Time) Registry Improvements Why are these priorities important to you/Other Comments?*Do you have healthcare?* Medi-Cal Medicare Private Insurance/other None If you had the option to apply for Fresno County IHSS Public Authority provided healthcare coverage for yourself, would you opt in?* Yes No Does not apply If no insurance, how has this affected you?*Bargaining TeamAre you interested in being a bargaining team? And/or is there another IHSS caregiver you would like to nominate to be on the bargaining team? (We will follow-up to provide an application and more information)* Yes No ActionsNow that you have shared your priorities, how are you willing to help win this contract? (Check all that apply)* Pass out a petition Participate in a virtual action Participate in a drive-thru and/or social distanced action Attend a Board of Supervisors Meeting via Zoom Connect with my coworkers by phone or virtually Call my County Supervisor or other legislators Talk to a community group Write a letter to a newspaper Share my story publicly Join my union’s Contract Action Team Are you a part of any club, community organization, non-profit or other membership organization? (If so please write the organization name and your role in that organization)* Will you take the first action and add your name to our petition which states: “We, the undersigned Caregivers, Consumers and Supporters of In-Home Supportive Services (IHSS), are calling upon decision makers – the public authority, the County, and State officials – to support our communities and bring dignity to the lives of Fresno County caregivers as essential workers by providing them with the rightful wages and benefits they deserve. When we lift caregivers out of poverty we are also lifting up our communities. Together We Rise!”?* Yes No We need to build support for this campaign, please forward this petition link: Time for $20 petition to family and/or friends who would like to support our petition. How many people can you send it to?Petition sending input* Share Your StoryWhy do you do homecare work? Why is your work important? What are some of the difficulties you face? How could better wages and benefits make things better?* How has the pandemic affected you, your recipient, your work environment?* At times, I’m unable to afford food, rent, medicine or other basic necessities:* Every month Several times per year I do not struggle to pay for basic necessities Can we share your story to help us win a strong contract?* Yes No If yes, please share your story here: seiu2015.org/get-involved/share-your-storyPhoneThis field is for validation purposes and should be left unchanged.