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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.
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1.
Please tell us about yourself.
(Required.)
Name:
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Company where you work:
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Address:
City/Town:
State:
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
*
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)
3.
I’m interested in a union primarily because it could help improve our:
Pay
Benefits
Staffing
Job Security
Fairness
Respect
Other (please specify)
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.
