HCII DORS Personal Assistant (Individual Provider) Membership Card

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 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.

Membership Authorization

I request and voluntarily accept membership in SEIU Healthcare Illinois & Indiana and its successors or assigns (collectively “HCII”). This means I will receive the benefits and abide by the obligations of membership set forth in both HCII’s and the Service Employees International Union’s (“SEIU”) Constitutions and Bylaws. I authorize HCII to act as my representative in collective bargaining over wages, benefits, and other terms and conditions of employment with the State of Illinois, and as my exclusive representative where authorized by law. My membership shall be continuous, unless I resign my membership by providing notice to HCII via U.S. mail (or other method if permitted by HCII’s policies). I know that union membership is voluntary and is not a condition of my employment, and that I can decline to join without reprisal.

Dues Deduction / Checkoff Authorization & Agreement

I voluntarily authorize and direct the State of Illinois to deduct from my earnings and to pay to SEIU Healthcare Illinois & Indiana and its successors or assigns (collectively “HCII”), and as directed by HCII, an amount equal to HCII’s regular dues, assessments, or fees. This authorization and agreement shall remain in effect unless I revoke it by sending written notice to HCII via U.S. mail (or other method if permitted by HCII’s policies) within 30 days before or after (1) the annual anniversary date of this authorization and agreement or (2) the termination of the applicable collective bargaining agreement between the State of Illinois and HCII (my “window periods”). This authorization will renew automatically from year to year even if I have resigned my membership, unless I revoke it during one of my window periods and as required by HCII’s policies.

HCII is authorized to deposit this authorization with my current Employer(s) and with any other Employer(s) under contract with SEIU in the event I change Employers or obtain additional employment. This authorization will remain effective if my employment with the Employer is terminated and I am later re-employed by the Employer.

This authorization and agreement 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 HCII are not tax deductible as charitable contributions.

I further authorize the State of Illinois to release to HCII personal and other information concerning me.