Profile Information

First Name: test
Personal Email: [email protected]
Last Name: test
Phone Cell: (555) 555-5555
Date of Birth: 2022-10-29
Phone Home:

Employment Information

Employee ID: 33333
Hire Date: 2022-10-29
Employer: Aesop
Department: test campus
Work Email: [email protected]
Work Location:
Job Description: test title

Consent

I recognize that I have submitted an application to join the Service Employees International Union-Florida Public Services Union and authorize a deduction of wages from my paycheck by my employer. I recognize that the union is under no obligation to represent me in regards to any investigation or disciplinary matter arising from facts or actions which occurred before I became a member in good standing with the union, and thus retains the right to deny representation in connection with the pending and preexisting disciplinary matter based on lack of union membership. I recognize that if the union refuses to represent me because of my lack of union membership then I may grieve and arbitrate on my own in accordance with the collective bargaining agreement. I recognize that for future matters, I will be treated in the same manner as any other member of the union with the union making a case-by-case determination on how to proceed through the grievance-arbitration procedure.

Date: 10/11/2022
Time: 11:06am
Signature: signature image

COPE

I further authorize my employer to deduct an additional $2.50 per week from my wages and remit to SEIU Florida Public Services Union (FPSU) as my voluntary COPE contribution. I understand this contribution is not a condition of union membership or of employment with any employer and that I have the right to refuse to sign this authorization and to refuse to contribute to COPE without reprisal. I understand that COPE funds will be used for political purposes, including but not limited to addressing political issues of public importance and contributing to and spending money in connection with federal, state and local elections. I further understand that any suggested contribution is merely a suggested guideline and that I am free to contribute more or less by this or some other means and that FPSU cannot favor or disadvantage me because of the amount of my contribution or my decision not to contribute. Contributions or gifts to SEIU FPSU COPE are not tax-deductible as charitable contributions. Only U.S. citizens or lawful permanent residents are eligible to contribute to COPE.

Date: 10/11/2022
Time: 11:06am
Signature: signature image