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WSNA Union Member Application

Welcome to the Washington State Nurses Association!

To download a copy of the application or view its contents for more information, select your facility from the 'Primary Facility' dropdown. Once selected, a new box will appear below the payment section with a download link.

All fields marked with an asterisk (*) are required.

CONTACT

First Name

Middle Initial

Last Name

Street Name

Unit, Apt, #, etc.

City

State

Zip

Personal E-mail

Cell Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)

Birth Year

Credentials

RN License #

Last 4 of the SSN

Gender

Race (Check all that apply)

EMPLOYER

Primary Employer

Facility

Date of hire (Start Date)

Unit/Department

Shift

FTE/Hours Worked Monthly

Per Diem

NoYes

Secondary/Additional Employer

Facility

Date of hire (Start Date)

Unit/Department

Shift

FTE/Hours Worked Monthly

Per Diem

NoYes

PAYMENT

SUPPORT NURSES, ELECT NURSES!

PAC Due Payment

SIGNATURE

Name

​WSNA Union Member Application