We’re Moving Forward with SEIU 721

Please note there are two sections with separate signature fields. The first signature is your request to no longer be represented by the Association of Long Beach Employees (ALBE). The second signature authorizes SEIU Local 721 to represent you. Please be sure to complete both sections.

"*" indicates required fields

Union Decertificaton Card

By signing this authorization card I declare that I no longer wish to be represented by the Association of Long Beach Employees (ALBE).

Name*

First Last

Employer*

Job Title*

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

Yes

Please check the box to confirm

Digital 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*

Union Authorization Card

I support working together with my co-workers for a voice in decisions that affect our professions and our future. I authorize SEIU Local 721 to represent me in collective bargaining with my employer concerning wages, hours, and other terms and conditions of employment. I understand that this authorization card will also be used by Service Employees International Union (SEIU) Local 721 to obtain recognition.

Name*

First Middle Last

Address*

Street Address City ZIP / Postal Code

Home Phone

Cell Phone*

Personal Email*

Date of Hire*