Application for CSEA Membership

I hereby authorize the Civil Service Employees Association, Inc. (CSEA), Local 1000 AFSCME, AFL-CIO, to be my exclusive representative for collective bargaining and therefore revoke any other representative that I may have previously designated. I also hereby authorize the fiscal or payroll officer of my employer to deduct CSEA dues from my salary in the amount certified by CSEA in this and succeeding years of my employment and membership.

Dues, contributions or gifts to CSEA are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses. I may revoke this authorization by sending a letter stating my intent to resign, along with my name, address, telephone number, CSEA ID number, and signature by United States Postal Service First Class Mail to: CSEA Statewide Secretary, Civil Service Employees Association, Inc., 143 Washington Avenue, Albany, N.Y. 12210.

Contact Information

Salutation

Check Box if you are a Veteran

First Name*

Middle Name

Last Name*

Nick Name

Date of Birth*

Address*

Address Line 2

City*

State*

Zip Code*

Home Email*

Do not give your work email address

Home Phone

Cell Phone

By checking this box I consent to receive calls (including recorded or autodialed calls or texts) at my cell phone number from CSEA and its affiliated labor organizations on any subject matter. You may modify your preferences by calling CSEA at 1-800-342-4146 or visiting the CSEA website at cseany.org

Employment

Employer

Employee Type

Job Local

Job Election Unit

Other Employer

NYS State ID / Employee Number

Social Security Number

Job Title*

Pay Type

Salaried

Hourly

Hourly Rate

Salary Range

Work Address*

Work Address Line 2

Work City*

Work State

Work Zip Code*

Work Phone