Submitting
SEIU 721
Southern California Public service Workers
SEIU 721 Membership Application. Para la versión en español
haga clic aquí
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Employer Name
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Select Employer
(SBCERA)San Bernardino County Employee Retiree Association
211 LA County
All Members
American Red Cross Blood Services (Socal)
American Red Cross Blood Services(San Jose)
Area Housing Authority of County of Ventura
Associate Members
Cabazon Water District
CalPERS
Casitas Municipal Water District
Channel Islands Beach
Children's Law Center of Los Angeles
City of Azusa
City of Baldwin Park
City of Beaumont
City of Carson
City of Compton
City of Duarte
City of El Monte
City of Hemet
City of Indio
City of Inglewood
City of La Puente
City of Long Beach
City of Los Angeles
City of Los Angeles Department of Water & Power
City of Monterey Park
City of Moorpark
City of Oxnard
City of Pasadena
City of Pico Rivera
City of Port Hueneme
City of Riverside
City of San Fernando
City of San Jacinto
City of Santa Ana
City of Santa Clarita
City of Santa Paula
City of Simi Valley
City of South Gate
City of Ventura
Clinica Monseñor Oscar A. Romero
Conejo Recreation and Parks
County of Los Angeles
County of Riverside
County of San Bernardino
County of Santa Barbara
County of Ventura
County Sanitation Districts of Los Angeles County
Gateways Hospital and Mental Health Center
Gold Coast Transit
Harbor Regional Center
HealthRIGHT 360 (Statewide 1021, 721, 221)
Housing Authority of the City of Los Angeles
LA City Retiree
LA County Retirees
LA SUPERIOR
LACERA
LACERA(LA county retiree system)
LACERS(LA City Retiree system)
Laguna College of Art and Design
LAHSA Los Angeles Homeless Services Authority
Lake Hemet Municipal Water District
Las Virgenes Municipal Water District
Los Angeles Community College District
Los Angeles County Law Library
Los Angeles LGBT Center
No longer in use-City of Compton/T&M
No longer in use-City of El Monte Mid-Managers
No longer in use-Pico Rivera Mid Management
North LA County Regional Center
Northeast Valley Health Corporation
Occidental College
Orange County Cemetery District
Otis College of Art and Design
Oxnard Harbor District
Palos Verdes Library District
Pleasant Valley Parks Department
ResCare Bright Spring (RSCR) Orange County
Riverside County Law Library
Riverside Retiree
SBCERS
SEAACA Southeast Area Animal Control Authority
SEIU 721 Staff
St. John’s Well Child and Family Center
Superior Court of CA, County of Riverside
Superior Court of CA, County of San Bernardino
Tri-Counties Regional Center
United Conservation Water District
VCERA(Ventura County retiree system)
Ventura Port District
Ventura Regional Sanitation District
Ventura Retirees
Watts Healthcare Corporation
Well Path (California Forensic Medical Group)
Whittier College
EmployeeID #
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LastName
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FirstName
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M.I.
DateOfBirth
Gender
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Female
HomeAddress
City
State
ZipCode
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NV
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Item#
JobTitle
HireDate
Annual Salary
WorkStatus
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Hourly/PartTime
Shift
Dept#
Department Name
Facility Name
FacilityAddress
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State
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CA
NV
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I agree to the
Membership Agreement
(required)
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I agree to the
Dues Deduction Agreement
(required)
By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis.SEIU will never charge for text message alerts.Carrier message and data rates may apply to such alerts.To unsubscribe, text STOP to 31996.For info, text HELP to 31996.
SEIU 721 MEMBER LIFE INSURANCE
Active SEIU721 members are automatically covered for $2,000 life insurance and an additional $2,000 for accidental death and dismemberment insurance ( a total of $4,000 if accidental death).
Primary Beneficiary
Relationship
Secondary Beneficiary
Relationship
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SEIU 721 Staff
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Membership Agreement
Yes, I want to join my fellow employees and become a member of SEIU Local 721! I request and voluntarily accept membership in SEIU Local 721 and its successors or assigns(collectively "Local 721").This means I will receive benefits and abide by the obligations of membership set forth in both Local 721's and the Service Employees International Union's Constitutions and Bylaws.I authorize Local 721 act as my representative in collective bargaining over wages, benefits and other terms/conditions of employment with my employer & as my exclusive representative where authorized by law.I know that union membership is voluntary and not a condicion of employment & that I can decline to join without reprisal
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Dues Deduction Agreement
I request and voluntarily authorize my employer to deduct from my earnings & to pay to Local 721 and its successors and assigns(collectively "Local 721") an amount to the regular monthly dues uniformly applicable to members of Local 721. This authorization shall remain in effect unless I revoke it by providing notice to Local 721 via U.S. mail(or other method if permitted by Local 721's policies) within 15 days before or after (1) the annual anniversary agreement date of this agreement Or (2) the termination of the applicable collective bargaining agreement between my employer and union (my "window periods").This authorization will renew automatocally from year to year even if I have resigned my membership, unless I revoke it during a window period and as required by Local 721's policies. This authorization is voluntary and is not a condition for my employment and I can decline to agree to it without reprisal. I understand that all members benefit from everyone's commitment because they help to build a strong union and is able to plan for the future. This authorization will remain effective if my employment with the employer ends and I am later re-employed by the Employer. It is my responsibility as 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 721.
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