Hawaii Government Employees Association - AFSCME Local 152, AFL-CIO

2019 Monthly Dues Rate for Bargaining Unit Membership*

Excluded Managerial Employee or Appointed/Elected Official $31.00

Excluded Confidential Employee $26.00

*Subject to change as authorized by HGEA’s Board of Directors or HGEA’s General Assembly without written notification.

Applicant Information

Required fields are marked with an asterisk*

Applicant Information

First Name:*

M.I.:

Last Name:*

Suffix:

Last 4 digits of SSN:*

Date of Birth:*

Gender:* Male Female Other

Contact Information

Please enter either a home or mailing address.*

Home Address 1:

Home Address 2:

City:

State:

Zip:

Mailing Address 1: (if different from home address above)

Mailing Address 2:

City:

State:

Zip:

Please enter either a home phone or cell phone number.*

Home Phone:

Cell Phone**:

**By providing my cell phone number, I understand that HGEA and its affiliates may use automated calling technologies and/or text message me on my cell phone on a periodic basis. The HGEA will not charge for text message alerts; carrier message and data rates may apply to such texts.

Home Email Address:

Subscribe to eBulletin:

If no Home Email Address is entered, you will not receive an email confirmation that your online application was received.

Work Information

Enter n/a for Employer/Department, Worksite, and Job Title if you are retired or unemployed.

Employer/Department:*

Worksite:*

Job Title:*

Work Phone:

Work Email:

Confirmation

Please review the information you have entered below. If you would like to change any information, click the Back button to go back to previous pages.

Applicant Information

First Name:

Middle Initial:

Last Name:

Suffix:

Date of Birth:

Gender:

Contact Information

Home Address 1:

Home Address 2:

Home City:

Home State:

Home Zip:

Mailing Address 1:

Mailing Address 2:

Mailing City:

Mailing State:

Mailing Zip:

Home Phone:

Cell Phone:

Home Email Address:

Subscribe to eBulletin:

Employment Information

Employer/Department:

Worksite:

Job Title:

Work Phone:

Work Email:

I hereby apply for membership in the Hawaii Government Employees Association, AFSCME Local 152, AFL-CIO (hereafter “HGEA”) and I agree to abide by its Constitution and Bylaws. I understand that I must meet HGEA's membership eligibility requirements before membership is approved; that approved membership will continue irrespective of changes in employment and until I submit written resignation of membership or my membership is terminated by HGEA in accordance with the HGEA Charter and Bylaws; that I am responsible for notifying HGEA of any change to the information provided on this form.

Employees excluded from collective bargaining must be a HGEA MCEC member in good standing for at least one year immediately preceding their request to be eligible for job-related representational services.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period the amount of dues certified by HGEA, and as they may be adjusted periodically by HGEA, and to authorize my Employer to remit such amount to HGEA.

Payments to HGEA are not deductible as charitable donations for federal income tax purposes. However, state law may extend favored tax treatment.

Check here if you agree to the above statements.*

Please enter your signature:*

and the last 4 digits of your SSN:*

MCEC Membership Application

Applicant Information

Applicant Information

Contact Information

Work Information

Confirmation

Applicant Information

Contact Information

Employment Information