UNION DUES/SERVICE FEE AUTHORIZATION
I, ______, hereby authorize Enloe Medical Center to deduct from my earned wages the first pay day of each month the amount I have selected below. Enloe Medical Center will pay that amount monthly to California Nurses’ Association on my behalf.
Check One
Regular Monthly Dues
(as of 07-01-2017):
___ Monthly rate is 2.2 times Base Hourly Rate of Pay
(Maximum of $143.05 per month)
Bargaining Unit Member working 24 or more hours per pay period
______x 2.2 = ______
Current Hourly Rate Monthly Dues
Service Fees
(as of 01-01-2017):
Equivalent to my share of the cost incurred by the Union related to collective bargaining, contract administration and grievance adjustment):
___ Non-member rate is 2.2 times Base Hourly Rate of Pay multiplied by 85.1%
Bargaining Unit Member working 24 or more hours per pay period
______x 2.2 x .851 = ______
Current Hourly Rate Monthly Dues
***** Monthly dues will be adjusted periodically as merit/market pay increases are awarded to employee
Per Diem and Casual status Employees are not eligible for Payroll Deduction
Charitable Contribution
I understand that if I am eligible for and elect a charitable contribution option, payroll deduction may not be used, and that I must make such contributions directly, and must provide documentation that I have made such contributions to C.N.A annually upon its request for documentation.
Please note contract language on reverse.
I understand that I may elect to revoke this payroll deduction authorization at any time upon thirty (30) days written notice to Enloe Medical Center, and that it will automatically expire upon the termination of the collective bargaining agreement between Enloe Medical Center and the Union.
Signature______Date______
Employee Name______ID #______
(please print) (6 digit # on front of Enloe ID badge)
Address______
______Phone ______
Text from the Collective Bargaining Agreement between Enloe Medical Center and the California Nurses Association running from August 7, 2012 through January 18, 2015.
ARTICLE 3
UNION SECURITY
Section A Nurse’s Obligation
During the term of this Agreement, any Registered Nurses hired by Enloe Medical Center after January 11, 2009 must, within thirty-one (31) days of employment in the bargaining unit, either join and maintain membership in the Union in good standing, or elect not to join and instead pay to the Union the applicable monthly service fee equivalent to his/her share of the costs incurred by the Union related to collective bargaining, contract administration and grievance adjustment.
Those Registered Nurses hired on or prior to January 11, 2009 who previously elected to decline Union membership and instead either pay to the Union the applicable monthly service fee equivalent to his/her share of the costs incurred by the Union related to collective bargaining, contract administration and grievance adjustment, or pay to a charitable organization exempt from taxation under Section 501©(3) of the Internal Revenue Code of his or her own choosing, the amount equal to the monthly service fee may continue to do so.
As an exception to the foregoing, during the term of this Agreement, any Nurse who possesses a good faith personally held religious belief or belongs to a religious organization that has among its tenets a conscientious objection to joining or financially supporting any labor organization may elect instead to contribute an amount equal to the service fee to one of the following nonreligious, non-labor organization charitable fund exempt from taxation under section 501 (c)(3) of title 26 of the Internal Revenue Code. Such Nurses shall be able to choose from one of the following charities: Habitat for Humanity, American Cancer Society, or American Heart Association. Nurses choosing this option must submit proof annually to the Association that they have made the required contribution. Such proof must be in the form of a cancelled check, a copy of a money order, or a statement from the receiving organization.
T:\Payroll\Forms\CNA dues deduct auth form for 07-01-2017.doc