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Membership Application |
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If you are not a member, we urge you to become one. It’s a simple application. You may download the application in pdf format by clicking here. (This document requires Adobe ® Reader ® to download and view. If you do not have Adobe ® Reader ® you may download it free.) Please complete the application and return it by mail to any of the Local’s Servicing Offices, or, the Central Office.
Grievance Form |
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The State of California Contract Grievance form (Rev 7/00) is in MS Word format and may be downloaded by clicking here. It can be filled out and returned by mail or FAX to any of the Local’s Servicing Offices, or, the Central Office.
Worker's Comp Doctor Designation Form |
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In accordance with the new workers' compensation reform law enacted April 19, 2004, you are allowed to pre-designate your primary care physician as your personal physician for your workers' compensation medical treatment. If you pre-designate your personal physician and provide notice of that pre-designation to your employer prior to any injury you will be allowed to be treated by your personal physician for any work-related injuries. Pre-designating your physician does not mean that you will not receive necessary emergency medical care nor does it mean that your personal physician will not be able to refer you to other specialists within the program in which you are enrolled. If you do not pre-designate your personal physician your employer or its workers' compensation insurer shall have sole control over your medical care for any work-related injury. A properly completed pre-designation of physician form should be given to your employer at the same time you present your dispatch slip. Separate and distinct pre-designation of physician forms should be tendered to every employer to whom you are dispatched. You should maintain a copy of each fully completed pre-designation of physician form with your personal records. You should contact your personal physician in order to assure that your personal physician agrees to pre-designation.
The Worker's Comp Doctor Designation form is in MS Word format and may be downloaded by clicking here.
