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*
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Home Phone
Cell Phone

Employment

Employer
Other Employer
NYS State ID / Employee Number
Social Security Number
Job Title*
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Hourly Rate*
Salary Range*
Work Address*
Work Address Line 2
Work City*
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Work Zip Code*
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