UNITED NURSES ASSOCIATIONS OF CALIFORNIA/UNION OF HEALTH CARE PROFESSIONALS, NUHHCE, AFSCME, AFL-CIO
Professional License No.
Adventist Health White Memorial Montebello
Bear Valley Community Hospital
Doctors Hospital of Riverside
Kaiser Permanente - DASH
Kaiser Permanente - Hawaii
Kaiser Permanente - Northern California
Kaiser Permanente - Southern California
Maui Health System
Naval Medical Center San Diego
Prime Healthcare Services
VA Loma Linda Healthcare System
Per Diem/Short Hour
VOLUNTARY DEDUCTION AUTHORIZATION
Pursuant to this Authorization and Assignment, the above-named Employer is requested to deduct from my pay, while I am employed within the collective bargaining unit of the Employer and irrespective of my membership status in the Union, a sum equal to the periodic dues, assessments, and/or fees, as designated by the Union. The Employer is requested to forward all sums promptly to the Union as designated above. The Union may advise the Employer from time to time of any changes to the said dues, assessments, and/or fees, and I request that the Employer immediately implement and deduct and forward the new sum(s) reflecting such change(s).
This Authorization and Assignment is voluntarily made in consideration for the cost of representation and collective bargaining, and is not contingent upon my present or future membership in the Union. This Authorization and Assignment shall remain in effect and shall be irrevocable unless I revoke it by sending written notice, with my signature, by U.S. mail or hand delivery to both the Employer and the Union no more than twenty (20) days and no less than ten (10) days immediately preceding the end of any yearly period subsequent to the date of this Authorization and Assignment or during the fifteen (15) day period immediately preceding the date of termination of the collective bargaining agreement in effect between the Employer and the Union, whichever occurs sooner, and shall be automatically renewed as an irrevocable check-off from year to year unless revoked as herein above provided.
I hereby request and accept membership in the above named Affiliate of the United Nurses Associations of California/Union of Health Care Professionals, NUHHCE, AFSCME, AFL-CIO, and of my own free will hereby authorize said Union, its officers, representatives and agents, to act for me as a collective bargaining agency in all matters pertaining to rates of pay/wages, hours of work, or other conditions of employment, and to enter into a Labor-Management Agreement which may require the continuance of my membership in said Union as a condition of my continued employment and may require the periodic dues and initiation fees uniformly required as a condition of acquiring or retaining membership.