LA City Council Union Authorization Card

I support working alongside my colleagues at the LA City Council to form a union to give us a stronger voice in decisions affecting our workplace, families, and future. My signature below indicates my desire to be represented by the Service Employees International Union (SEIU) Local 721 for the purpose of meeting and conferring with my employer on wages, hours, and other terms and conditions of employment. I understand this authorization card will be submitted to the Employee Relations Board to establish support among employees for an election and/or to obtain recognition of SEIU Local 721 as the exclusive collective bargaining representative.

Employee Information

First Name*

Middle Initial

Last Name*

Email Address*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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 Address*

Street Address City Zip Code

Work Phone

Employer*

Employer Address

Street Address City Zip Code

Council Office

Field or City Hall

Employee ID #

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*