Application for OSEA Membership : OSEA

Application for OSEA Membership

(Fill out all required fields, which have an * next to them. The optional life insurance and ELAF are available after submitting this application. You must click on Submit at the bottom of this page for us to receive your application.)

* Required field

Last name *

First name *

Middle name

Preferred name

Mailing Address *

Apt No

City *

State *

Zip *

Home phone

Cell phone

Work phone

Home email

Work email *

Date of birth *

Last 4 of SSN *

Employer/School district *

Date of hire

Job title / Classification

Worksite

Previously employed with an OSEA chapter? *

Yes

Payroll Deduction for Membership Dues: You must sign, date, and press the submit button (at the bottom) to be a member.

Signature *

Reset Signature

Signature is required.

Date *

Yes, I hereby apply for membership in OSEA. I wish to be represented by OSEA as my sole and exclusive collective bargaining representative for all matters relating to wages, hours, and other terms and conditions of employment. By submitting this application, I request and voluntarily authorize my employer to deduct from my wages the monthly membership dues as certified by OSEA to my employer. This authorization shall remain in effect until cancelled by me in writing to OSEA and my employer, and I understand that I may do so at any time. If an increase or decrease in dues is adopted by OSEA members, this authorization shall include the then-established dues and no new authorization shall be required.

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