• Application for CIR/SEIU Membership - Rutgers Biomedical & Health Sciences

  • Welcome to the Committee of Interns and Residents/SEIU! CIR/SEIU negotiates for improved salaries, benefits, and working conditions for House Staff. It is run by and for House Staff. Your dues are the main source of support for CIR/SEIU activities.

  • CIR NY Office: (212) 356-8100  info@cirseiu.org  www.cirseiu.org 

  • Member Information

  • Hire Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Birth
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • *By providing my phone number, I understand that CIR, SEIU, and their affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. CIR and SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP TO 787753 for more information.

  • Payroll Deduction Authorization

  • YES, I recognize the need for a strong union and believe everyone represented by our union should pay their fair share to support our union’s activities. I hereby request and voluntarily authorize my employer, when and only when I am on its payroll, to deduct from my earnings and to pay over to CIR an amount equal to the regular weekly, bi-weekly, or monthly dues (1.6% of base pay) uniformly applicable to members of CIR, SEIU. This authorization shall remain in effect unless I revoke it by sending written notice to withdraw said authorization to CIR or my employer via email or U.S. mail. The withdrawal will become effective on the 30th day after the anniversary date of my employment.

    This authorization is voluntary and is not a condition of my employment, and I can decline to agree to it without reprisal. I understand that all members benefit from everyone’s commitments because they help to build a strong union that is able to plan for the future.

    Dues, contributions, or gifts paid to CIR are not tax deductible as charitable contributions.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Please note you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature.

  • Membership Authorization

  • Yes, I want to join with my fellow employees and become a member of the Committee of Interns and Residents ("CIR"). I request and voluntarily accept membership in CIR. This means I will receive the benefits and abide by the obligations of membership set forth in the Constitutions and Bylaws of both CIR and the Service Employees International Union ("SEIU"). I authorize CIR to act as my representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer, and as my exclusive representative where authorized by law. My membership will be continuous unless I resign by providing notice to CIR by U.S. mail or email. I know that membership in CIR is voluntary and is not a condition of employment, and that I can decline to join without reprisal.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Please note you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature.

  • SEIU COPE (Committee on Political Education) Authorization

  • YES, I want to be an advocate for my patients. Sign me up to contribute to SEIU COPE

  • I hereby authorize my employer to deduct:

  • from my paycheck, and transfer the funds as a voluntary contribution to SEIU COPE I understand that: 1) I am not required to sign this form or make SEIU COPE contributions as a condition of my employment by my employer or membership in the union; 2) I may refuse to contribute without any reprisal; 3) Only union members and executive/administrative staff who are U.S. citizens or lawful permanent residents are eligible to contribute to SEIU COPE; 4) The amounts on this form are merely a suggestion, and I may contribute more or less by this or some other means without fear of favor or disadvantage from the union or my employer; 5) SEIU COPE uses the money it receives for political purposes, including but not limited to addressing political issues of public importance and contributing to and spending money in connection with federal, state and local elections. Contributions to SEIU COPE are not deductible for federal income tax purposes. This authorization shall remain in effect until revoked in writing by me and sent to CIR/SEIU Healthcare Local 1957 or my hospital's payroll office. I recognize that my/any contribution through payroll deduction is completely voluntary and in compliance with State law. It shall be unlawful for any person soliciting an employee for contribution to such a fund to fail to inform such employee of his or her right to refuse to contribute without reprisal. Any questions relative to compliance with election law may be directed to the Election Law Enforcement Commission, 28 West State Street, Trenton, New Jersey 08625, (609) 292-8700.

  • Date
     / /
    2 digit month, 2 digit day, 4 digit year

  • Please note you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature.

  • Should be Empty: