Electronic Authorization for Representation UNAC/UHCP - NorCal Therapist

Electronic Authorization for Representation

UNITED NURSES ASSOCIATIONS OF CALIFORNIA/UNION OF HEALTH CARE PROFESSIONALS,
NUHHCE, AFSCME, AFL-CIO

By signing this card, I am showing Kaiser that I want a union and when 50 percent plus 1 of us sign cards, Kaiser has agreed to recognize the union. When that happens we will become union members and we will have a direct voice through the union and through the Kaiser Labor-Management Partnership in the operations of both our union and our workplace.

Name*

First Name

Middle Name (optional)

Last Name

Cell Phone*

Employee ID #*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Email Address*

Service Area*

City

Hire Date

MM / DD / YYYY

Shift Status

Day Evening Night

Unit/Department

Classification*

(PT, OT, ST, Etc)

Job Status

Full Time Part Time Per Diem

By signing below, I hereby authorize United Nurses Associations of California/Union of Health Care Professionals, to represent me as my exclusive Representative for the purpose of collective bargaining; concerning wages, hours of work and other conditions of employment. By signing this card, I am showing Kaiser that I want a union and when 50 percent plus 1 of us sign cards, Kaiser has agreed to recognize the union. When that happens we will become union members and we will have a direct voice through the union and through the Kaiser Labor- Management Partnership in the operations of both our union and our workplace.*

[clear]

Use your mouse or finger to draw your signature above

For information, please call, in confidence, 800-762-5874.