SEIU 521 Membership Application

First Name*
Last Name*
MI
License #
Address*
Zip Code*
City
State
Home Phone
Cell Phone†
Personal Email*

†By Providing my phone number, I understand that CCPU-CA/Local 521, the Service Employees International Union (SEIU), its local unions, and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. CCPU-CA/Local 521 and 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.

I request and voluntarily authorize Child Care Providers United California("CCPU-CA"), a joint partnership of SEIU and AFSCME and its successors or assigns, to act as my representative in collective bargaining with respect to my subsidy payments, and other terms and conditions of my work as a child care provider, and as my exclusive representative where authorized by law. I also request and voluntarily accept membership in CCPU-CA and SEIU Local 521("Local 521"). This means I will receive the benefits and abide by the obligations of membership set forth in the Constitutions and Bylaws of CCPU-CA, Local 521, and the Service Employees International Union("SEIU"). My membership will be continuous, unless I resign by providing notice to Local 521 via U.S. Mail (or other method permitted by Local 521's policies). I know that membership in CCPU-CA and Local 521 is voluntary and is not a condition of my work as a childcare provider, and that I can decline to join without reprisal.

Clear
Nov-21-2024

I request and voluntarily authorize the State of California to deduct from my earnings and to pay to CCPU-CA/Local 521 an amount equal to the regular monthly CCPU-CA/Local 521 membership dues. This authorization shall remain in effect unless I revoke it by providing notice to Local 521 via U.S. mail (or other method if permitted by Local 521's policies) within 15 days before or after (1) the annual anniversary 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 automatically from year to year even if I have resigned my membership, unless I revoke it during a window period and as required by Local 521's policies. This authorization is voluntary and is not a condition of my work as a child care provider, and I can decline to agree to it without reprisal. I understand that all members benefit from everyone's commitments because they help to build a strong union that is able to plan for the future.

Contributions or gifts to CCPU-CA/Local 521 are not tax deductible as charitable contributions.

Clear
Nov-21-2024

Help Working Families Gain A Stronger Voice
by Signing up for SEIU Committee On Political Education (SEIU COPE)

Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together.

I hereby authorize the State of California to withhold the indicated amount per month to forward to CCPU-CA/Local 521 as a contribution to SEIU Committee on Political Education ("SEIU COPE"). My signature shows that I agree with the terms below and authorize a monthly deduction of:

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 work as a childcare provider or membership in the union; (2) I may refuse to contribute without reprisal; (3) Under 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 amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or disadvantage from CCPU-CA/Local 521 or the State of California; (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 or other permissible method to CCPU-CA/Local 521.

Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.

Clear
Nov-21-2024