20100128_OrganizingRequest Organizing Information Request Please tell us a little about yourself and where you work and we will contact you with information about how forming a Union can help you win dignity and respect in your workplace. Question Title * 1. Please tell us about yourself. Name: * Company where you work: * Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: * Question Title * 2. What type of company do you work for? •Hospital Nursing Home Home Care Agency Mental Health Agency Head Start Agency Community Action Agency Library Developmental Disabilities Center Higher Education Other Health Care Agency Other Public Sector Agency or Department Other (please specify) Question Title * 3. I’m interested in a union primarily because it could help improve our: Pay Benefits Staffing Job Security Fairness Respect Other (please specify) Question Title * 4. I heard about SEIU from: Coworker Friend/Relative News Internet Other (please specify) Thank you for taking the first step towards winning a voice at your workplace. We will be contacting you soon to follow up on the information you have submitted. Done
