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* 1. PSA Membership number

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* 2. First Name

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* 3. Surname

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* 4. Work email

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* 5. Mobile number (if you do not have a mobile please provide your work number)

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* 6. In which area of Department of Education do you work?

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* 7. What is your workplace address (Address of Office Building)

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* 8. What is the clerk grade of your role?

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* 9. Are you employed on a permanent or temporary basis?

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* 10. What is your job title?

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