- Membership and Authorization
- for salary deduction
Name
First:
Middle:
Last:
Address
Street:
Apt/Unit #:
City:
State:Zip
Code:
Date of birth
Month/Date/Year:
Social Security number:
Home phone number:
School/Building name:
School voice mail number:
Email address:
Gender:
Position- I am a:
Subject (for classroom teachers only)-
The majority of the day I'll be teaching
- Secondary school subject:
-
- Elementary grade level:
-
Political Party Affiliation (optional)-
If you are registered, please identify
party: (choose one)
Ethnicity
(choose one) (optional):
Authorization for monthly dues deduction from salary
Please read carefully:
- I hereby request and authorize Jeffco Public Schools (District)
to deduct from my earnings and transmit to the Jefferson County
Education Association (JCEA) the amount determined by JCEA, CEA,
NEA each year, to be deducted and transmitted in equal installments
pursuant to Article 37 of the Negotiated Agreement. This authorization
shall continue in full force and effect unless revoked by me
in writing and delivered to the JCEA office between September
1st and 15th of any calendar year after the date designated below
or authorized by vote of the JCEA Board of Directors. I understand
that along with my dues the Association will collect voluntary
political contributions called Every Member Option (EMO). Members
may request that those contributions be refunded by JCEA and
/or CEA by notifying each organization in writing prior to December
15.
-
- Tax note: Dues are not deductible ascharitable contributions
for federal income tax purposes. Dues payments (or a portion
thereof) may be deducted as a miscellaneous itemized deduction.
-
- I have read the above and want to submit this authorization
form to JCEA for membership processing. I understand I
will become a member on the date of transmittal. JCEA will send
a new-member packet within 30 days.
Welcome to JCEA!