Kaiser Member Interest Card

United Nurses Association of California Union of Health Care Professionals

REPRESENTATION AUTHORIZATION

Please complete all information

NUHHCE ∙ AFSCME ∙ AFL-CIO

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

PERSONAL Email*

Cell Phone*

Unit/Dept*

Classification*

(e.g., RN, PA, PT, PharmD, etc.)

Hire Date*

Shift Status

Day Evening Night

Job Status

FT PT Per Diem

Employer*

I hereby authorize United Nurses United Nurses Associations of California/Union of Health Care Professionals, to represent me and to bargain collectively with my Employer on my behalf.*

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Use your mouse or finger to draw your signature above

Date/Time*

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.

For information please call in confidence 800-762-5874