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Employment Information My Employer/Facility County Location * Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba Do you have a second employer? My 2nd Employer/Facility County Location * Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba Membership Authorization Form
I hereby apply for membership in SEIU Local 2015 ("Local 2015" or "the Union") and agree to abide by its Constitution and Bylaws. By this application, I authorize Local 2015 to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my employer.
Do you agree with the membership terms? * Dues Authorization Form
I recognize the need for a strong union and believe everyone represented by our union should pay their fair share to support our union's activities. I hereby request and authorize my employer to deduct from my earnings and to pay over to SEIU Local 2015 those Union dues and fees that may now or hereafter be established by the Union. This authorization shall remain in effect regardless of my membership status, and shall be automatically renewed for successive periods of one year, unless I revoke it by sending written notice via U.S. mail to SEIU Local 2015 during the fifteen ( 15) day period before the annual anniversary date of this agreement. This authorization will remain effective if my employment with the Employer is terminated and I am later re-employed by the Employer. Contributions or gifts to SEIU Local 2015 are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.
Do you agree to the Dues Authorization Terms above? * Caregivers Action Fund (COPE) Authorization
Yes! I want to hold politicians accountable to working families!
The Caregivers Action Fund (COPE) program is vital to keeping the In Home Supportive Services program alive. The government directly funds our program, so we need political power to advocate for ourselves and our clients and to keep winning strong contracts.
Because of members’ investments in the Caregivers Action Fund (COPE), we’ve been able to win huge increases in our state minimum wage, increase state funding for in Home Supportive Services, and elect representatives to Congress that are fighting to expand Medicaid and make quality affordable care available to all Americans.
Full program description and terms are listed below. Yes, I want to contribute to the following amount to SEIU COPE per month (please select one):
Caregivers Action Fund (COPE) Authorization
Yes, I want to join fellow caregivers in taking action to elect champions for Long Term Care workers and our communities and hold them accountable to act in the best interest of caregivers and those who receive our care.
I hereby authorize the Office of the State Controller of California to withhold the indicated amount per month to forward to SEIU Local 2015 as a contribution to the Caregivers Action Fund. Caregivers Action Fund is acting as a collecting agent for SEIU COPE.
This authorization is made voluntarily based on my specific understanding that; (1) I am not required to sign this form or make voluntary contributions to the Caregivers Action Fund (SEIU COPE) as a condition of my employment or membership in the union; (2) I may refuse to contribute without reprisal; (3) under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to the Caregivers Action Fund (SEIU COPE); (4) the contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear of disadvantage from SEIU Local 2015 or my employer; (5) Caregivers Action Fund (SEIU COPE) uses the money it receives for political purposes – including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices – and addressing political issues of public importance.
This authorization shall remain in effect until revoked by me in writing to SEIU Local 2015 via U.S. mail or other permitted method.
Do you agree with the Caregivers Action Fund (COPE) Authorization terms above? Union Security Notice Terms
Every employee working under an SEIU Local 2015 (“Local 2015” or the “Union”) collective bargaining agreement is entitled to hold membership in the Union. To be a member in good standing of the Union, you must meet your financial obligations to the Union under the SEIU Local 2015 Constitution and Bylaws. You can become a member by working in a bargaining unit covered by a Local 2015 collective bargaining agreement and paying the full Union dues rate. However, we recommend that you fill out and sign this online membership form to confirm your Union membership. Additionally, we recommend that you fill out and sign the attached payroll deduction authorization card, as it is the easiest way to ensure that you satisfy your financial obligation to the Union each month.
Union membership is a valuable benefit. Union members – and only Union members – are entitled to run for and hold Union office, to serve as shop stewards, to elect Union of officers, to elect shop stewards, to attend Union meetings, to ratify collective bargaining agreements, and to vote on constitutional changes (for example, changes to the dues structure), or on other matters of union governance. The Union also provides seminars and other training opportunities, some of which are open only to Union members, and union membership is required to participate in other benefits (for example, the Union Plus Program, which provides qualified SEIU members with mortgage and disability assistance, credit counseling, disaster relief, and discounts on wireless service, computers and numerous other consumer items and services). Moreover, the greater the participation of all Union employees, the stronger the Union; the stronger the Union, the better position we are in to negotiate better wages, benefits, and working conditions.
If you prefer not to become or remain a member of the Union and to forfeit these important benefits of Union membership, you have a right to not be a member of the Union. As an employee working under a Union security or agency fee agreement, however, even if you choose not to become a member or you resign your Union membership you will be required to pay periodic fees to the Union as a condition of employment. These fees are your fair share of sustaining the Union’s collective bargaining and other programs that support you, your fellow Union members, and all working families. Each non-member may be charged a fee up to an amount that is equal to the periodic amount of regular membership dues and initiation fee (unless you have already paid the initiation fee). However, each nonmember has the further right to object and pay a fair share fee limited to his or her proportionate share of the Union’s expenditures for collective bargaining, contract administration, grievance adjustment, contract enforcement, and other activities germane to the Union’s duties as bargaining representative (called “representational activities”). This reduced fee is called an “Objector fee.” Non-members also have a right to obtain from the Union sufficient financial information to enable them intelligently to decide whether to object to paying for expenses that are not germane to representational activities, to challenge the Union’s calculation of the Objector fee, to have such challenges resolved in a prompt manner by a neutral, third-party arbitrator, and to be informed of the procedures for filing and resolving such challenges. If you would like to be a non-member and pay this Objector fee instead, you must send an Objection letter, personally signed by yourself, to Membership Dept, SEIU Local 2015, 2910 Beverly Blvd., Los Angeles, CA 90057-1003, stating that you object to supporting Union activities unrelated to collective bargaining. Such Objection letter must include your name, mailing address, facility name, daytime telephone number where you can be reached, and the last four digits of your social security number. If you provide this notice of your desire not to be a Union member, the Union will continue to represent you fairly and will send you a periodic fee notice that informs you of the amount of the fee for the upcoming fee year, of your right to object to paying for Union activities that are not germane to representational activities, of the basis for the Union’s calculation of the Objector fee, of your right to challenge that calculation, of the procedure for exercising these rights to object and to challenge, and of other related matters.
An employee who chooses not to be a Union member forfeits valuable rights. We therefore strongly encourage you to protect the fruits of collective bargaining by remaining an active member of the Union. Whether you pay dues as a Union member or choose to pay fees as a non-member, you will be required to pay your dues or fees on a monthly basis. The easiest way to ensure you are in compliance with this requirement is to sign the portion of the attached document entitled “Authorization Form” so that your employer can deduct the required dues or fees directly from your paycheck. If you do not authorize these deductions, then you will be responsible for providing the Union with payment directly on a month-to-month basis.
By clicking here I confirm I have read the Union Security Notice terms above *
By clicking join, you accept that your printed name, IP address and the date and time will be used as your digital signature for the purposes of becoming an official member of SEIU Local 2015.