Name and Contact Information

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Council 4 is compiling an impact survey on the 2016 state employees initiated by Gov. Malloy. We want to use this information as part of our campaign to fight layoffs and service cuts. Ideally we want to use your information to share with the public and with legislators if you approve of us doing that. Otherwise, the surveys are confidential. We will not share any information without your approval.

* 1. Please provide your name and contact information

* 2. When Were You Laid Off and From What Agency?

* 3. What Is Your AFSCME Council 4 Local Union? (Leave blank if not sure)

* 4. What Was Your Job Title at the Time of Your Layoff?

* 5. How Many Years of Service at Your Most Recent Agency? How Many Years of State Service Overall?

* 6. What Was Your Base Salary at the Time You Were Laid Off?

* 7. What Were Your Job Responsibilities? Be As Detailed as Possible.

* 8. What Is the Impact of Your Layoff On Your Co-Workers, On Your Agency's Mission and the Public In General? Be As Detailed As Possible.

* 9. Would You Be Willing To Share Your Impact Story With Legislatorsr and the Media as well as Council 4 Newsletter, Website, Facebook Page, etc?

* 10. Do You Have Any Additional Comments or Suggestions?