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* 1. Your Name:

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* 2. Personal E-mail Address:

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* 3. Best Phone Number to Reach You:

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* 4. Phone Type:

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* 5. Job Classification:

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* 6. In what facility or location do you work?

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* 7. Our salaries have been tied to total compensation as reported by Salary.com. Would you like this practice to continue or would you like salary benchmarks to be tied to a different source?

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* 8. Are you satisfied with your incentive pay formula?

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* 9. Tuition Reimbursement: Our tuition reimbursement should:

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* 10. Annual Leave: I would like our annual leave to:

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* 11. Members have expressed an interest in accruing Sick Leave in addition to Annual Leave. Are you willing to trade some of your Annual Leave hours to a dedicated Sick Leave bank, which can be rolled over year after year?

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* 12. For most physicians, Holidays must be deducted from Annual Leave if one does not work on a specific holiday.  Would you like to have Holidays paid separate from your Annual Leave?

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* 13. It is important to negotiate over these issues:

  Important Issue Somewhat Important Not an Issue
Compensation Improvements
Healthcare Improvements
Retirement Improvements
Work Hours Improvements
Other Issues (Specify Below)

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* 14. In this round of negotiations, the Bargaining Committee should have as its goal:

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* 15. Use the space below to offer other suggestions for the Bargaining Committee.

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