Membership Application for Non-LAUSD Employees

    The Basics

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    Employment Information

    Who is your employer?
    What school or work site do you work at?
    What is your job title?
    What school or work site do you work at?
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    What college do you work at?
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    What is your job title?
    What school or work site do you work at?
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    Which program do you work in?
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    What division are you in?
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    What is your unit?
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    Terms of Membership and Confirmation

    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.

    Do you agree to the Terms of Membership and accept membership into SEIU Local 99? Yes

    Dues Authorization & Terms

    I hereby authorize my Employer(s) to deduct from my compensation and pay to Service Employees International Union (SEIU) Local 99, 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 Local 99. This authorization is voluntarily made and it 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 occurs 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 the Union and my Employer, whichever is shorter, unless I give written notice to the Union of not more than twenty-five (25) days and not less than ten (10) days prior to the expiration of each one year period or the then current collective bargaining agreement, whichever occurs sooner. My dues deduction authorization shall automatically terminate if my employment terminates or I otherwise cease to be a member of the bargaining unit. 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.

    Do you understand and agree to the Dues Authorization and Terms? Yes

    Which SEIU Local 99 organizer pointed you here, if any?