Please make sure that you read all authorization language thoroughly and type your name in the digital signature authorization box provided so your authorization can be processed. 

MEMBERSHIP AUTHORIZATION

We're Stronger Together, SEIU Members are untied across race, religion, industry, and geography to improve our jobs and our communities. 

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. 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 a form of electronic communication. I know that union membership is voluntary and not a condition of employment and that I can decline to join without reprisal. 

AGENCY FEE PAYER AUTHORIZATION

I do not wish to be a member of SEIU Local 500 and will pay the agency fee as required. I understand by making this choice, I relinquish my right to vote on my contract, serve on committees, and give up access to member benefits. To obtain information sufficient to gauge the propriety of the agency fee, along with a description of the procedures to be followed in accordance with your rights under the law, click here for more information.

AUTHORIZATION FOR PAYROLL DEDUCTION

I request and voluntarily authorize my employer to deduct from my earnings and to pay Local 500 and its successors and assigns 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 in the form of electronic communication within 15 days before or after (1) the annual anniversary date of the agreement or (2) the termination of the applicable collective bargaining agreement between my employer and the union. This authorization will renew automatically from year to year even if I have resigned my membership unless I revoke it during one of my window periods and as required 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. 

Note:  Contributions or gifts to Local 500 are not tax-deductible as charitable contributions. 

When Workers Unite, Politicians Listen
Building Our Political Power

COPE, which stands for the Committee on Political Education, is a Political Action Committee (PAC) fund used to support issues important to working families and hold politicians accountable. Union dues cannot be used for political purposes; therefore members are making voluntary contributions to SEIU 500's COPE PAC fund so that we can help elect candidates who stand up for issues important to working families. Please select the amount you wish to contribute below.

SEIU  Local 500 COPE (PAC) 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 above 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.

Voluntary contributions will be deducted in the authorized amount beginning on the first full pay period following receipt of this authorization by payroll. 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.