PARI-MUTUEL EMPLOYEES GUILD

PARI-MUTUEL EMPLOYEES GUILD

of CALIFORNIA, SEIU LOCAL 280

- GENERAL OFFICE -

1838 East Huntington Drive

Duarte, California 91010-2672

(626) 301-7900

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MEMBERSHIP APPLICATION

Print Name__________________________________________________________________

(Last) (First) (Middle)

Mailing Address______________________________________________________________

City ______________________________ State ___________ Zip Code ________________

Social Security No. ____- ___- ____ Birth Date ___/___/___ Marital Status S _____ M ____

Phone Number (Home) (___) __________ Phone Number (Other) (___) ________________

In an Emergecy Contact ________________________________________________________

Address __________________________ City ___________ State ___ Zip Code __________

Phone Number (___) ____________ Relationship ___________________________________

Present Occupation/Job Description _______________________________________________

____________________________________________________________________________

Present Employer _________________________________ Telephone No. (___) __________

Address_________________________________ City __________ State __ Zip Code ______

Are you a member of any union _____ Local # ____ Trade _____________________________

How long as a member ______ Have you ever been rejected or suspended from any union ____

If yes, explain _________________________________________________________________

____________________________________________________________________________

Along with this Application, it is mandatory that you include the following items: Photostat copy of your valid California Horse Racing Board Pari-Mutuel License and copies of each payroll stubs totalling fiveteen (15) days or more worked in a Pari-Mutuel Classification within the immediately preceding eighteen (18) months.

(See other side)

(PMEG) 06/97

California Horse Racing Board Pari-Mutuel License # _____________ Employee # __________

Schooled/Trained at ________________ First Day Worked as a Pari-Mutuel Clerk ___/___/___

List jobs worked (or trained) as a Pari-Mutuel Clerk ___________________________________

_____________________________________________________________________________

List any other job or jobs worked other than a Pari-Mutuel Clerk in the Racing Industry _______

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List of Racetracks/Satellites worked Date worked

_____________________________ ___________

In compliance with requirements, please answer the following, Are you: Female ____ Male ____

American Indian ____ Asian ____ Black ____ Caucasian ____

Spanish Surnamed ____ Oriental ____ or Other ____

Have you ever been convicted of a felony in the past five (5) years ____ If yes, explain ________

_____________________________________________________________________________

Have you ever been bonded ____ or been denied bonding ____ If yes, explain _______________

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PLEASE READ CAREFULLY THE FOLLOWING CERTIFICATE OF APPLICANT, BEFORE SIGNING

“I have full knowledge and complete understanding that my acceptance into membership of SEIU Local 280 does not guarantee me any employment, nor does it in any manner obligate SEIU Local 280 to guarantee me any employment. I fully understand and agree that, upon my acceptance into membership, I will freely and willingly abide by the Constitution and Bylaws, and Work Rules of SEIU Local 280.” “I hereby certify that the foregoing answers, declarations and attachments are true and correct.”

______________________________________________________________ ____________________

Signature of Applicant Date

- FOR OFFICE USE ONLY-

APPLICATION FOR MEMBERSHIP RECEIVED ON ____________

(PMEG) Rev 06/97