INSTRUCTIONS FOR SELECTING YOUR UNION STATUS:

Employees must select either Membership or Agency Fee Payer or Request an Exemption. If you elect to be a union Member or an Agency Fee Payer and wish to have your deductions taken from your paycheck, make sure you authorize the Payroll Deduction section of this form. If instead, you choose to pay by check, complete the Direct Pay Authorization below and you will receive an invoice for the semester or the entire academic year. Employees who are covered by an exemption category can be members of the union but are not required to pay the agency fee (with the exception of category 8). See the list of exemption categories. 

STEP 1 - Choose Your Union Status:

MEMBERSHIP AUTHORIZATION

I request and voluntarily accept membership in SEIU Local 500 and I agree to abide by the obligations of membership set forth in the Constitution & Bylaws of both Local 500 and the Service Employees International Union ("SEIU"). I authorize SEIU Local 500 to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer. I know that membership in the union is voluntary and is not a condition of my 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.

STEP 2 - Choose How To Pay:

AUTHORIZATION FOR PAYROLL DEDUCTION

In payment for initiation fees, and membership dues or an agency fee, to SEIU Local 500, I hereby authorize and direct American University to deduct from my pay an amount equal to the dues or agency fees in the amounts specified by SEIU Local 500, and to pay that amount to SEIU Local 500 in accordance with the terms of the Collective Bargaining Agreement between American University and SEIU Local 500. This authorization will remain in effect each year, or until canceled in writing by me and received by the Union. I understand that, unless exempted under Section 9.6(D), if I was hired by American University for first time after June 1, 2013, the obligation to pay dues or fees, either by payroll deduction or some alternative method, is a condition of my employment as an Adjunct with American University.

Note:  Dues, fees, and assessments paid to the Union are not tax-deductible as charitable contributions. However, they may be tax-deductible as ordinary and necessary business expenses.

DIRECT PAY ARRANGEMENTS: 

**If you authorized payroll deduction, do not complete this section.

I understand that if I elect to make direct pay arrangements that the Union will invoice me that amount due for either membership dues or agency fees, including any initiation fees, for the entire semester or the academic year. I also understand that failure to pay the amount due by the specified date on the invoice will result in a non-compliant union status that could effect future employment with my employer.

Request for Exemption Status

I believe that I am covered by an exemption category that exempts me from the requirement to pay an agency fee. I understand that the Union must verify this status at the beginning of each semester that I am teaching. For more detailed information about the exemption categories, visit "My Workplace" and scroll to the bottom of the page. If you request an exemption, make sure that all the boxes above are unchecked. 

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.