Join SEIU 1199nw

New Membership Form

By joining together in a union, SEIU Healthcare 1199NW members speak with a united voice for quality healthcare and good jobs.
Be a part of the movement for quality care for our community. Fill out this form to join.

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First Name*

Last Name*

Personal Email*

Cell Phone*

‡ 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 Healthcare 1199NW 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.

Hospital/Clinic/Agency*

Job Title

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Today's Date*

We’re Stronger Together – Membership application

Yes, I want to join with my co-workers and become a member of SEIU Healthcare 1199NW. This means I will receive the benefits and abide by the Constitution and Bylaws of both SEIU Healthcare 1199NW and Service Employees International Union (SEIU). I authorize SEIU Healthcare 1199NW as my representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer, and as my exclusive representative where authorized by law. I know that membership in the union is voluntary and not a condition of my employment, and that I can decline to join without reprisal.*

Yes, I authorize the above.

Signature*

Yes I’m standing with my co-workers – Authorization for payroll deduction

I request and voluntarily authorize my employer to deduct from my earnings and to pay SEIU Healthcare 1199NW an amount equal to the regular monthly dues uniformly applicable to members of SEIU Healthcare 1199NW. This authorization shall remain in effect unless I revoke it by sending written notice via U.S. mail to SEIU Healthcare 1199NW during the period of not less than 30 days and not more than 45 days before either (1) the annual anniversary date of this agreement, or (2) the date of termination of the applicable collective bargaining agreement between the employer and SEIU Healthcare 1199NW. This authorization shall be automatically renewed from year to year unless I revoke it in writing during a window period, even if I have resigned membership. If I have a break in employment with all Employers that have a Collective Bargaining relationship with SEIU Healthcare 1199NW and resume employment with such an Employer within twelve (12) months, this authorization shall remain in effect. This authorization is voluntary and is not a condition of my employment, 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 SEIU Healthcare 1199NW are not taxable as charitable contributions.*

Yes, I authorize the above.

Signature*

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Section Break

Notice of Rights For Private Sector Employees

*Dues are 1.8 percent of your pay.