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personal-information-1
First Name
*
Middle Name
Last Name
*
billing-address
Mailing Country
*
United States of America
Mailing Address
*
Mailing City
*
Mailing State
*
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
US Virgin Island
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
*
personal-information-2
Personal E-mail
*
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home Phone (Telefono de Casa)
custom-field-2
Cell phone (telefono movil)
*
custom-field-3
work phone (telefono del trabajo)
custom-field-4
employee id (id de empleado)
*
custom-field-5
annual salary (salrio anual)
custom-field-6
date of birth (fecha de nacimiento)
*
Date
E.g., 2023-03-30
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position (titulo de trabajo)
custom-field-8
subject taught (tema que enseñas)
custom-field-9
school or worksite (sitio de trabajo)
*
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hours worked per day (horas de trabajo por dia)
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referred by (referido por)
payroll-deduction
membership-wrapper
Select your membership category
Select your membership category
Full-Time (Tiempo Completo)
Part-Time (Medio Tiempo)
Dues Amount
$0.00
Total
* draft
privacy-policy
legal-wrapper
Authorize
I hereby agree to pay, and authorize my employer to deduct, the dues and assessments described above and as are certified by the Association to the School Board for each year thereafter from my salary and direct and authorize my employer to pay such amounts to the Association in accordance with payroll deduction procedures in effect; provided, however, I may cancel my membership and this authorization by filling out the cancellation form provided by the Seminole UniServ office. Deducción De Paga: Por la presente consiento en pagar y autorizar a mi empleador a deducir las cuotas y las calificaciones descritas arriba y como son certificadas por la Asociación a la Junta Escolar para cada año posterior de mi salario y directamente y autorizo a mi empleador a pagar tales cantidades a la Asociación De acuerdo con los procedimientos de deducción de nómina vigentes; Sin embargo, Puedo cancelar mi membresía y esta autorización llenando el formulario de cancelación proporcionado por la oficina de Seminole UniServ.
Deductions - Deducciones
Print your name
Date
Date
E.g., 2023-03-30
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