SEIU 775 Caregiver Info Material Order Form

Most orders take 5-10 business days to process and will be shipped via UPS. (Individual contracts may be sent via the US Postal System.)

If you do not receive your materials within 14 business days, please email our Member Resource Center at mrc@seiu775.org.

MATERIALS AVAILABLE:

CDWA New Employee Orientation (NEO) packet:
- One English membership form
- One English Collective Bargaining Agreement (CBA) with Consumer Direct WA
- One WA voter registration card
Agency New Employee Orientation (NEO) packet:
- One English membership form
- One English Collective Bargaining Agreement (CBA)
- One of each of the SEIU 775 Benefits Group Training flyers: Basic Training, Continuing Education, Health Benefits, and Secure Retirement Plan
SEIU 775 Membership Forms (available in English, Spanish, Russian, Simplified Chinese, Vietnamese, and Korean)
Collective Bargaining Agreement (CBA)

1. Name (Who is placing this order)

First NameLast Name

2. Name (Recipient of ordered material, if different than above)

First NameLast Name

3. Address (where to mail ordered material)

Street Address

Street Address Line 2

CityState

Zip Code

4. Your Phone Number

Format: (000) 000-0000.

5. Your Email

example@example.com

6. Your Affiliation

7. Select your employer/contract name.

This will ensure we send you the right contract and ensure we pre-print the correct Employer on any membership forms you request. (For example, if you work for CDWA or are a CDWA caregiver, you should select, "WA - Consumer Direct WA / State of WA").

8. How many NEO packets do you need? (CDWA and Agencies only)

See above for what's included.

9. Full Collective Bargaining Agreement: How many copies of the full CBA of the previously selected employer would you like to order? This is in addition to any NEO packets, if you order those. | Note: Not all CBAs have been translated ahead of time, an additional 3-4 weeks may be required for translation and then printing of any translated CBAs. All current translations of CBAs are available on our Contracts page. If you would like to request CBAs in languages not listed, please add what languages into the “Comments/questions” box below and we will evaluate the request before confirming with you via email.

Rows	Quantity
English
Spanish
Russian
Simplified Chinese
Korean
Vietnamese

10. Membership Forms: How many copies of our Membership Form would you like to order? This is in addition to any NEO packets, if you order those.

Rows	Quantity of Washington Form	Quantity of Montana Form	Quantity of Alaska Form
English
Spanish
Russian
Simplified Chinese
Korean
Vietnamese
Amharic
Arabic
Khmer
Somali

11. SEIU 775 Benefits Group Caregiver Welcome Guide: How many packs of 25 would you like to order? (CDWA and WA Agencies only). Orders will be fulfilled by the Benefits Group.

1 = 25 copies, 2 = 50 copies, 3 = 75 copies, 4 = 100 copies, etc. - only available to be ordered in packs of 25.

12. Comments/questions