JOIN OUR UNION:
AUTHORIZATION AND MEMBERSHIP APPLICATION

Yes, I want to join with my fellow employees and become a member of SEIU Healthcare Minnesota & Iowa.

I request and voluntarily accept membership in SEIU Healthcare Minnesota & Iowa while I am employed by my current employer and while I am employed by any future employers that have contracts or bargain collectively with SEIU Healthcare Minnesota & Iowa. This means I will receive the benefits and abide by the obligations of membership set forth in the Constitutions and Bylaws of both SEIU Healthcare Minnesota & Iowa and the Service Employees International Union (“SEIU”).

I authorize SEIU Healthcare Minnesota & Iowa to act as my representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my current employer and any future health care employers in Minnesota, and as my exclusive representative where authorized by law. I know that membership in the union is voluntary and is not a condition of my employment, and that I can decline to join without reprisal.

CONTACT INFORMATION

First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State*
Zip Code*
Personal Email
Home Phone
Work Email
Cell Phone*
I do not have an email address. I understand I will not receive a copy of this form.

EMPLOYMENT

Sector*
Employee No.
Employer*
Job Title
Worksite
Shift
Department
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