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.

* 1. Contact Information

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

* 3. Date of Layoff Notice

Date of Layoff Notice

* 4. Effective Date of Layoff

Effective Date of Layoff

* 5. Date of Hire

Date of Hire

* 6. Official Duty Station

* 7. Current Job Classification

* 8. Date of Hire Into Current Job Class

Date of Hire Into Current Job Class

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