Member Application

Haz clic en la bandera en la esquina superior derecha para cambiar al español. ^^
Member Application

Please complete the following form to join over 15,000 healthcare workers, janitors, and security officers who make Oregon and Washington a great place to work and live.
Your information
Name

PrefixFirst NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Personal Email
example@example.com
Stay Informed. 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 receiving messages. Text HELP to 787753 for more information.
* 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 receiving messages. Text HELP to 787753 for more information.
Work information
Employer
Facility/Work Location
Department/Unit
Job Title
Date of Hire

MonthDayYear
Date
Employee #
Work Email
example@example.com
Primary Language Spoken
Membership commitment
Sign here to commit
Automatic Dues Deduction/Checkoff Authorization: I hereby request and voluntarily authorize my employer to deduct from my earnings and to pay over to SEIU an amount equal to the regular monthly dues* uniformly applicable to members of SEIU. This authorization is irrevocable for a period of one year from the date of execution and from year to year thereafter unless I send, via U.S. mail, signed written notice to SEIU of my desire to revoke authorization not less than thirty (30) and not more than forty-five (45) days prior to the end of the annual period from the date of this execution or the termination of the applicable contract between my employer and my Union, whichever occurs first. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing during the window period, even if I have resigned my membership in SEIU. Sign here to authorize.
* Contributions or gifts to SEIU are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.
Should be Empty:

Member Application

Your information

Work information