Pasadena City College Union Authorization Card

"*" indicates required fields

I support working alongside my co-workers at Pasadena City College to create a stronger voice in decisions affecting our workplace, families, and future. I authorize Service Employees International Union, Local 721 to represent me for the purpose of meeting and negotiating or meeting and conferring with my employer regarding my wages, hours, and other terms and conditions of employment.

Employee Information

First Name*

Middle Initial

Last Name*

Email Address*

Cell Phone

By providing my cellular telephone 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. To stop receiving messages, text STOP to 721721. Text HELP to 721721 for more information.

Home Phone

Home Address*

Street Address City Zip Code

Employer*

Department

If you work in a specific department please list it. If not please leave it blank.

Shift

Employer Address

Street Address City Zip Code

Signature

YES, I UNDERSTAND AND AGREE TO THE TERMS ABOVE.*

Please check the box above to confirm

Electronic Signature*

BY CLICKING SUBMIT, YOU ACCEPT THAT YOUR PRINTED NAME, IP ADDRESS AND THE DATE AND TIME WILL BE USED AS YOUR DIGITAL SIGNATURE FOR THE PURPOSES OF THIS FORM.

Today's Date*