SEIU Local 99

UNION MEMBERSHIP APPLICATION

1The Basics

2Employment Information

3Terms

4Contribute to COPE

5Review your application

The Basics

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City ZIP Code

Date of Birth(Required)

Mobile Phone

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Home Phone

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Would you like to receive occasional text notifications from Local 99?(Required)

Local 99 will never charge you for text message alerts, but carrier message and data rates may apply. Text STOP to stop receiving messages.

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Personal Email

Stay up-to-date on the news around bargaining and other issues that impact your job and community. If you do not have a personal email, leave this blank. Do not put your work email here.

Work Email

If your employer does not provide a work email to employees or you don't have a work email, leave this blank.

Employment Information

Your employer or bargaining unit(Required)

What is your employee ID number?(Required)

This refers to your employer-issued ID number. Do not enter your phone number here.

Your preferred language

What is your license status?

Licensed

Licensed exempt

What is your date of hire?(Required)

Do you work at a school or non-school facility?(Required)

At a school

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What LAUSD school do you work at?(Required)

If you can't find your school on the list, type keywords into the search bar. For example, if you work at Edward Roybal Learning Center, search for 'Roybal'.

Enter the name of your school(s) / work site(s) at LAUSD(Required)

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What is your job classification/title at LAUSD ?(Required)

What Compton USD school do you work at?(Required)

What is your job title at Compton USD?(Required)

What HLPUSD school do you work at?(Required)

What is your HLPUSD job title?(Required)

What LACCD college do you work at?(Required)

What is your LACCD job title?(Required)

What is your LACOE job title?(Required)

What Lynwood USD school do you work at?(Required)

What is your Lynwood USD job title?(Required)

Which MAOF program do you work in?(Required)

What is your MAOF job title?(Required)

What is your job title at Montague Charter Academy?(Required)

Which division do you work in?(Required)

What is your job title?(Required)

What PVSD school do you work at?(Required)

What is your job title at PVSD?(Required)

What SMMUSD school or work site do you work at?(Required)

What is your job title at SMMUSD?(Required)

What is your unit at TAS?(Required)

What Torrance Unified school do you work at?(Required)

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What VCCCD college or office do you work at?(Required)

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Enter your job classification/title(Required)

Terms of Membership

I hereby apply for membership into Service Employees International Union (SEIU) Local 99. I hereby voluntarily accept membership into SEIU Local 99. I agree to abide by SEIU Local 99's Constitution and Bylaws and by SEIU's Constitution and Bylaws. I authorize SEIU Local 99 to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer.

By signing in the box below, I agree to the Terms of Membership and accept membership into SEIU Local 99.(Required)

I request and voluntarily authorize Child Care Providers United California (CCPU-CA), a joint partnership of SEIU and AFSCME, to act as my representative in collective bargaining with respect to my subsidy payments, and other terms and conditions of my work as a child care provider, and as my exclusive representative where authorized by law. I also request and voluntarily accept membership in CCPU-CA and SEIU Local 99 (“Local 99”). This means I will receive the benefits and abide by the obligations of membership set forth in the Constitutions and Bylaws of CCPU-CA, Local 99, and the Service Employees International Union (“SEIU”). I know that membership in CCPU-CA and Local 99 is voluntary and is not a condition of my work as a child care provider, and that I can decline to join without reprisal.

By signing in the box below, I agree to the Terms of Membership and accept membership into SEIU Local 99/CCPU-CA.(Required)

Dues Authorization & Terms

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 authorize my Employer(s) to deduct from my compensation and pay to Service Employees International Union (SEIU) Local 99, irrespective of my membership in the union, amounts equivalent to membership dues and assessments as duly adopted by SEIU Local 99. If for any reason, my Employer fails to make a deduction, I authorize the Employer to make such deduction in the subsequent payroll period. SEIU Local 99 is authorized to submit this authorization to my Employer(s) under contract with SEIU Local 99. This authorization is irrevocable for a period of one year or until the termination of the presently existing collective bargaining agreement between the Union and my Employer, whichever is sooner. Also, I agree this authorization shall be automatically renewed and shall be irrevocable for successive periods of one year or for the period of each collective bargaining agreement between SEIU Local 99 and my Employer unless I give written notice via U.S. mail to the Union during the period not more than twenty-five (25) days and not less than ten (10) days prior to (1) the annual anniversary date of this agreement or (2) the date of termination of the applicable collective bargaining agreement between the employer and SEIU Local 99. My dues deduction authorization shall automatically terminate if my employment terminates, or I otherwise cease to be a member of the bargaining unit. This dues authorization will remain effective, however, if my employment with the Employer ends and I am later re-employed by the Employer. This dues authorization is voluntary and is not a condition of my employment, and I can decline to agree without reprisal. I understand that all members benefit from everyone’s commitments because they help build a strong union that is able to plan for the future. It is my responsibility as a member to notify the union if I believe my deductions are incorrect or if I am no longer in a bargaining unit represented by SEIU Local 99.

Contributions or gifts to SEIU Local 99 are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses.

I request and voluntarily authorize the State, or any contractor or other entity that processes subsidy payments I receive from the State, to deduct from my earnings and to pay to CCPU-CA/Local 99 an amount equal to the regular monthly CCPU-CA/Local 99 membership dues. This authorization shall remain in effect unless I revoke it by sending written notice via U.S. mail to Local 99's headquarters during the fifteen (15) day periods before either: (1) the anniversary date of this agreement or (2) the date of termination of the applicable contract between the State and CCPU-CA/ Local 99. This authorization shall be automatically renewed from year to year unless I revoke it in writing during a window period, even if I have resigned my membership.

This authorization is voluntary and is not a condition of my work as a child care provider, and I can decline to agree to it without reprisal. I understand that all members benefit from everyone's commitments because they help to build a strong union that is able to plan for the future.

Contributions or gifts to CCPU/Local 99 are not tax deductible as charitable contributions.

By signing in the box below, I understand the union dues terms and authorize deductions for union dues.

Contribute to COPE: Invest in Quality Education, Good Jobs, and a Better Future

Public education is funded by local, state and federal governments. That means as employees in public education, the work we do is directly affected by policy decisions. The school board members we elect vote on our contracts. State leaders decide on the education budget and how much money goes to local school districts and agencies. Federal officials decide on funding for school transportation, special education, lunch programs, child care services, Head Start, and so much more. That’s why having a strong voice in politics is critical to our jobs, and the well-being of our communities. In addition to voting and mobilizing others to vote, we make our voices heard in politics by contributing to SEIU Local 99’s Committee on Political Education Fund (COPE). Your contribution is voluntary. Through COPE, union members can pool our money together to pass laws that support working people and elect leaders that value public education and the issues we care about. Learn more about COPE.

Choose your monthly COPE contribution amount:

$20

$15

$10

Other amount

I'd like to learn more about COPE first

Enter an amount(Required)

I hereby authorize my employer to withhold the indicated amount per month to forward to SEIU Local 99 and its successors and assigns (hereinafter “Local 99”) as a contribution to SEIU Committee on Political Education (“SEIU COPE”). If I am retired, I will remit my COPE contribution with my dues payment. By submitting this form, I agree with the terms below. 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 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 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 favor or disadvantage from SEIU or my employer; 5) 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 via U.S. mail to SEIU Local 99 – 3530 Wilshire Blvd. #1800, Los Angeles, CA 90010.

Contributions or gifts to SEIU’s COPE Fund are not tax deductible as charitable contributions.

I hereby authorize the State, or any contractor or other entity that processes subsidy payments I receive from the State, to deduct from my earnings each pay period and to pay to CCPU-CA/Local 99 the amount indicated on this card as a contribution to SEIU Committee on Political Education (“SEIU COPE”). My signature shows that I agree with the terms below.

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 SEIU COPE as a condition of my work as a child care provider 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 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 or disadvantage from CCPU-CA/Local 99 or the State; (5) 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.