Membership Card

As a UEMSW Local 4911 member, you’ll gain access to exclusive benefits and privileges, including:

Voting on the contract that governs your job—including wages, benefits, and work hours
Attending member-only meetings and having a say in decisions that impact your job
Supporting your fellow members as well as workers across California and the U.S. to lobby for better pay and working conditions for First Responder professionals and their support staff.

UEMSW Local 4911 Membership entitles you to full Membership rights in the union, including the right to attend union meetings, vote to ratify union contracts, vote in union elections, hold union office, and vote on constitutional changes or other matters of union governance.

First Name

Middle Initial

Last Name

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Name of Employer

Department/County

Job Class

Full Time

Part Time

Personal Email

Cell Phone †

† By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences at https://www.afscme.org/tcpa.

YES! I am AFSCME Strong. I want a strong voice at work and in my community.

No, I am choosing not to be a member.

Authorization for Payroll Deduction for Union Dues

I hereby apply for membership in United EMS Workers Local 4911/AFSCME (hereafter the “Union”) and I agree to abide by its Constitution and Bylaws. I authorize the Union and its successor or assign to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my Employer.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, regardless of whether I am or remain a member of the Union, the amount of dues certified by the Union, and as they may be adjusted periodically by the Union, and to authorize my Employer to remit such amount monthly to the Union.

This voluntary authorization and assignment shall be irrevocable, regardless of whether I am or remain a member of the Union, for a period of one year from the date of execution or until the termination date of the collective-bargaining agreement (if there is one) between the Employer and the Union, whichever occurs sooner, and for year to year thereafter unless I give the Employer and the Union written notice of revocation not less than ten (10) days and not more than twenty (20) days before the end of any yearly period. This card supersedes any prior check-off authorization card I signed.

I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.

Payments to the Union are not deductible as charitable donations for federal income tax purposes. However, state law may extend favored tax treatment.

Union Security Notice Terms

Every employee working under an UEMSW Local 4911, AFSCME (“ UEMSW” “Local 4911” or the “Union”) collective bargaining agreement is entitled to hold membership in the Union. To be a member in good standing of the Union, you must meet your financial obligations to the Union under the UEMSW Local 4911, AFSCME Constitution and Bylaws. You can become a member by working in a bargaining unit covered by a Local 4911 collective bargaining agreement and paying the full Union dues rate. However, we recommend that you fill out and sign this online membership form to confirm your Union membership. Additionally, we recommend that you fill out and sign the attached payroll deduction authorization card, as it is the easiest way to ensure that you satisfy your financial obligation to the Union each month.

Union membership is a valuable benefit. Union members – and only Union members – are entitled to run for and hold Union office, to serve as shop stewards, to elect Union of officers, to elect shop stewards, to attend Union meetings, to ratify collective bargaining agreements, and to vote on constitutional changes (for example, changes to the dues structure), or on other matters of union governance. The Union also provides seminars and other training opportunities, some of which are open only to Union members, and union membership is required to participate in other benefits (for example, the Union Plus Program, which provides qualified AFSCME members with mortgage and disability assistance, credit counseling, disaster relief, and discounts on wireless service, computers and numerous other consumer items and services). Moreover, the greater the participation of all Union employees, the stronger the Union; the stronger the Union, the better position we are in to negotiate better wages, benefits, and working conditions.

If you prefer not to become or remain a member of the Union and to forfeit these important benefits of Union membership, you have a right to not be a member of the Union. As an employee working under a Union security or agency fee agreement, however, even if you choose not to become a member or you resign your Union membership you will be required to pay periodic fees to the Union as a condition of employment. These fees are your fair share of sustaining the Union’s collective bargaining and other programs that support you, your fellow Union members, and all working families. Each non-member may be charged a fee up to an amount that is equal to the periodic amount of regular membership dues. However, each nonmember has the further right to object and pay a fair share fee limited to his or her proportionate share of the Union’s expenditures for collective bargaining, contract administration, grievance adjustment, contract enforcement, and other activities germane to the Union’s duties as bargaining representative (called “representational activities”). This reduced fee is called an “Objector fee.” Non-members also have a right to obtain from the Union sufficient financial information to enable them intelligently to decide whether to object to paying for expenses that are not germane to representational activities, to challenge the Union’s calculation of the Objector fee, to have such challenges resolved in a prompt manner by a neutral, third-party arbitrator, and to be informed of the procedures for filing and resolving such challenges. If you would like to be a non-member and pay this Objector fee instead, you must send an Objection letter, personally signed by yourself, to UEMSW Treasurer, UEMSW Local 4911, 175 Bernal Rd #205, San Jose, Ca 95123, stating that you object to supporting Union activities unrelated to collective bargaining. Such Objection letter must include your name, mailing address, Employer name and location, daytime telephone number where you can be reached, and the last four digits of your social security number. If you provide this notice of your desire not to be a Union member, the Union will continue to represent you fairly and will send you a periodic fee notice that informs you of the amount of the fee for the upcoming fee year, of your right to object to paying for Union activities that are not germane to representational activities, of the basis for the Union’s calculation of the Objector fee, of your right to challenge that calculation, of the procedure for exercising these rights to object and to challenge, and of other related matters.

An employee who chooses not to be a Union member forfeits valuable rights. We therefore strongly encourage you to protect the fruits of collective bargaining by remaining an active member of the Union. Whether you pay dues as a Union member or choose to pay fees as a non-member, you will be required to pay your dues or fees on a monthly basis. The easiest way to ensure you are in compliance with this requirement is to sign the portion of the attached document entitled “Authorization Form” so that your employer can deduct the required dues or fees directly from your paycheck. If you do not authorize these deductions, then you will be responsible for providing the Union with payment directly on a month-to-month basis.

Signature

My electronic signature is a binding and valid signature. By signing here I acknowledge that I have fully read and understood the Union Security Notice Terms. I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments.

PEOPLE: Fighting for Candidates Who Will Fight for Us

Across the country, Americans are facing an out-of-balance economy that favors the wealthy while wages remain stagnant for everyone else. Working families are struggling to get ahead and public services are under attack. AFSCME PEOPLE, our union’s political action fund, provides us with an opportunity to stand together to protect the benefits and rights we’ve won in our workplaces and our communities.

We must take an active role to elect politicians who advocate for issues that are important to working families, like the need to balance the economy, defend workers’ rights, secure workers’ benefits, invest in public services, and ensure a secure retirement for all. By contributing today, you can help elect local, state and federal candidates who will fight for us and the issues we care about most.

This section is completely voluntary. You do not have to sign up for a PEOPLE contribution. It is not the same as signing up for union membership.

Deduction per pay period

$9.62 MVP

$4.20 MVP

Other amount

If you would like a PEOPLE jacket, select your size:

Small

Medium

Large

2XL

3XL

(available with minimum $4.20 per pay period contribution)

PEOPLE Authorization

I hereby authorize my employer and associated agencies to deduct each pay period the amount certified as a voluntary contribution to be paid to the treasurer of American Federation of State, County, and Municipal Employees PEOPLE, AFSCME, AFL-CIO, P.O. Box 65334, Washington D.C. 20035-5334, to be used for the purpose of making political contributions and expenditures. My contribution is voluntary, and I understand that it is not required as a condition of membership in any organization, or as a condition of continued employment, and is free of reprisal. I understand that any contribution guideline is only a suggestion and I am free to contribute more or less than that amount and will not be favored or disadvantaged due to the amount of my contribution or refusal to contribute, and that I may revoke this authorization at any time by giving written notice.

Signature for PEOPLE Contribution only

In accordance with federal law, AFSCME PEOPLE will accept contributions only from members of AFSCME and their families. Contributions or gifts to AFSCME PEOPLE are not deductible as charitable contributions for federal tax purposes.