Local 2001 Layoff Intake Form : All Units 2017

Instructions

1. Anyone who receives a layoff notice should fill this form out completely. If you can not submit this form online, or if you experience computer/internet errors, please either print and mail the completed form to: CSEA SEIU Local 2001, 760 Capitol Ave, Hartford, CT 06106 or call 800-894-9479 to request a hard copy to be mailed to you.

2. Contact your union steward or chapter president immediately. He/She will make sure that your contractual rights are not being violated.

3. Immediately write a memo to your HR office stating, "As a member of the CSEA SEIU Local 2001 [bargaining unit name], I wish to exercise my contractual bumping rights. Please keep me advised." You should hand deliver the memo to your agency personnel office and retain a date stamped copy for your records.

Question Title

* 1. Contact Information

Name:

Mailing address:

Preferred phone number:

Email address:

Question Title

* 2. Bargaining Unit Name - (example: Orange Board of Education Secretaries)

Question Title

* 3. Date of Layoff Notice

Date of Layoff Notice

Date

Question Title

* 4. Effective Date of Layoff

Effective Date of Layoff

Date

Question Title

* 5. Date of Hire

Date of Hire

Date

Question Title

* 6. Official Duty Station

Name of Official Duty Station

Address of Duty Station

Question Title

* 7. Current Job Classification

Question Title

* 8. Date of Hire Into Current Job Class

Date of Hire Into Current Job Class

Date

Question Title

* 9. Are You In Your Working Test/Probationary Period?

Yes