Issue link: https://nnumagazine.uberflip.com/i/198564
Election:2008 10/19/07 11:37 AM Page 31 RN EXPERIENCE How long have you been an RN? ____ years. List present employment first: Employer _______________________________________ City ________________________Department ___________________________________ Title _____________________________________ From (year) ___________________________ to (year) ____________________________________ Employer _______________________________________ City ________________________Department ___________________________________ Title _____________________________________ From (year) ___________________________ to (year) ____________________________________ CNA/NNOC EXPERIENCE Start with present or most recent experience. List activities and positions held. Collective Bargaining __________________________________________________________________________________________________________ Organizing New Facilities _____________________________________________________________________________________________________ State _________________________________________________________________________________________________________________________ National ______________________________________________________________________________________________________________________ Other _________________________________________________________________________________________________________________________ MEMBERSHIP INFORMATION I have been a member of the California Nurses Association/National Nurses Organizing Committee since _____(year). I am willing to accept the responsibilities of this position. Date: ______________________________________Signature: ________________________________________________________________________ MEMBER'S STATEMENT OF INTEREST Please write a brief statement (50 words maximum), indicating how your involvement would help increase the power of registered nurses and the California Nurses Association/National Nurses Organizing Committee to advocate for RNs, patients, and a just healthcare system. (Statements will be truncated after 50 words.) _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ Signature _________________________________________________________Name ______________________________________________________ ——————————————————————————————————————————————————————————————————————————— FOR OFFICE USE ONLY: Member ID #: ___________________________________________________Status: ______________________________________________________ Date: _______________________________________________________Checked by: ______________________________________________________ OCTOBER 2007 W W W. C A L N U R S E S . O R G REGISTERED NURSE 31