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* 1. Name:

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* 2. Email address:

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* 3. Store Number:

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* 4. Home or Cell Phone Number:

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* 5. Job Classification:

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* 6. How many years have you worked for CVS?

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* 7. What is your current rate of pay?

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* 8. Are you full-time or part-time?

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* 9. Have you signed up for the union health plan?

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* 10. Do you believe that your Health Plan is a superior plan worth protecting?

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* 11. Please number the following issues from 1-7 in terms of their importance to you and your coworkers (1 being the most important and 10 being the least important)

  1 2 3 4 5 6 7
Wage Increase
Health & Welfare Benefits
Protecting Pension
Increased Hours
Promotional Opportunities
Job Security
Preferred Hours/Schedule

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* 12. Are you willing to volunteer to help obtain a good contract?

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* 13. What other issues do you want the union to address in the next contract negotiations?

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