MEMBERSHIP AUTHORIZATION

Yes, I want to join my fellow employees and become a member of SEIU Local 500! I request and voluntarily accept membership in SEIU Local 500 and its successors or assigns (collectively "Local 500"). This means I will receive the benefits and abide by the obligations of membership set forth in both Local 500's and the Service Employees International Union's Constitutions and Bylaws. I authorize Local 500 to act as my representative in collective bargaining over wages, benefits, and other terms/conditions of employment with my employer and as my exclusive representative where authorized by law. My membership will be continuous unless I resign by providing notice to Local 500 via U.S. mail (or other method if permitted by Local 500's policies). I know that union membership is voluntary and not a condition of employment and that I can decline to join without reprisal.

AUTHORIZATION FOR PAYROLL DEDUCTION

I request and voluntarily authorize my employer to deduct from my earnings and to pay to Local 500 and its successors and assigns (collectively "Local 500") an amount equal to Local 500's regular dues. This dues deduction authorization shall remain in effect unless I revoke it by providing notice to Local 500 via U.S. mail (or other methods if permitted by Local 500's policies). This authorization is voluntary and is not a condition of my employment, and I can decline to agree to it 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.

Dues and fees paid to Local 500 are not tax deductible as charitable contributions. 

When Workers Unite - Politicians Listen

SEIU COPE CHECKOFF AUTHORIZATION

I authorize SEIU Local 500 to file this payroll deduction form with my employer and for my employer to withhold the amount specified below to forward to SEIU Local 500 as a contribution to SEIU Committee on Political Education (“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 SEIU COPE as a condition of my employment or membership in the union; 2. I may refuse to contribute without reprisal; 3. Under the 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 amount on this form is merely a suggestion, and I may contribute more or less by this or other means without fear of favor or disadvantage from my union 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 Local 500. After receipt of this authorization by payroll, voluntary contributions will be deducted in the authorized amount beginning on the first full pay period.

I hereby authorize my employer to deduct: (the amount specified below) from my paycheck each pay period for SEIU COPE, subject to the terms set forth above, under SEIU COPE CHECKOFF AUTHORIZATION.