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Home » Membership Application

Membership Application

For our patients, for our profession - Join SEIU Nurse Alliance, Local 121 RN

Membership Applicationwayne2025-02-23T21:06:32-08:00

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As registered nurses and professionals, we must unite to protect our patients and our profession in today's world of healthcare. It takes resources and the involvement and strength of many members to be an effective organization, not just in the hospital, but in our communities and across California and the nation. So if you're not already a member, now's the time to join! Dues are 1.65% of your base rate, for hours paid, up to 80 in a pay period (excludes differentials, premium pay, and overtime).

To be a part of our united effort to achieve the improvements we need and lead the way to a better healthcare system and better future for our patients and our profession, simply fill out this form.

Name*
Gender*

Birthdate*
Home Address*
Personal Email

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. Text STOP to 787753 to stop messages. Text HELP to 787753 for more information.

I support working together with my RN and Professional colleagues for a voice in decisions that affect our patients, our profession, and our future. I, therefore, authorize the Service Employees International Union (SEIU) Nurse Alliance, Local 121RN to represent me in collective bargaining with my employer. I hereby voluntarily request and accept membership in SEIU121RN as my union and representative with my employer concerning wages, hours and other conditions of employment, and as my exclusive representative where authorized by law. This means I will receive the benefits of, and I agree to abide by, the SEIU121RN Constitution and Bylaws and all amendments thereto and by any contracts in existence at the time of this application or that may be negotiated by the union.
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COPE Authorization

I want to build our Nurse-Powered Politics program, which helps us win strong laws that protect our profession and our patients, improve the health of Californians and raise the standard of living for healthcare and other essential workers.

I hereby authorize SEIU121 RN to file this payroll deduction with my employer and for my employer to deduct the following monthly amount and transfer the funds as my voluntary contribution to SEIU Committee on Political Education (COPE) and to transfer such funds to SEIU121 RN/PAC:*

I am not required to sign this form or make COPE contributions as a condition of my employment or membership in the union; I may refuse to contribute without any reprisal; only union members and executive/administrative staff who are U.S. citizens or legal U.S. residents are eligible to contribute to SEIU Committee on Political Education (COPE). The amounts on this form are merely a suggestion, and I may contribute more or less by this or some other means without fear of favor or disadvantage from the union. SEIU Committee on Political Education (COPE) uses the money it receives for political purposes, including but not limited to addressing political issues of public importance and spending money in connection with federal, state and local elections. This authorization shall remain in full force and effect until revoked in writing by me via U.S. Mail. My signature shows that I have reviewed and agreed with the terms stated here.

Contributions or gifts to SEIU121 RN are not tax deductible as charitable contributions.

Clear Signature

Payroll Deduction Authorization

By signing below, I hereby authorize my employer to deduct from my wages an amount equal to regular dues uniformly applicable to members of SEIU121 RN and to transmit that amount to SEIU121 RN, including with respect to any union dues or fees that have previously been paid in that manner. This authorization shall remain in effect unless I revoke it by sending written notice to both the employer and SEIU121RN by U.S. Mail during the period not less than thirty (30) days and not more than forty-five (45) days before the annual anniversary date of this agreement, or the date of termination of the applicable contract between the employer and SEIU121RN, whichever occurs sooner, and shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing during the window period, irrespective of my membership in SEIU121 RN. 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.

Contributions or gifts to SEIU121 RN are not tax deductible as charitable contributions.

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* By providing my mobile phone number and clicking yes to opt into texts, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my mobile phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.
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Request Your Union Contract

Your Union contract—also called a Collective Bargaining Agreement—is a legally-binding document that guarantees your terms of our employment, including pay, benefits, hours, holidays, sick leave, seniority, job safety and more. To request a copy of the contract for your facility, fill out all fields in the form below. We will match the information you provide to our records, and we will send you a digital copy of the contract.

Name
Opt-in to receive text alerts
* By providing my mobile phone number and clicking yes to opt into texts, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my mobile phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.
Do you have a representational need and want your Union Rep/Organizer to follow up with you?(Required)

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