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* 1. What is your name?

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* 2. Which federal agency were you removed from?

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* 3. What was your official work location (city and state)?

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* 4. What was the date you were hired (e.g. entered on duty/EOD)?

Date

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* 5. What was your position title?

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* 6. Where you in the competitive or excepted service?

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* 7. What is the effective date of your dismissal?

Date

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* 8. Do you have written notification of your dismissal?

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* 9. Upload written documentation of your dismissal, if available.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 10. What reason were you given for your dismissal?

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* 11. Prior to your dismissal, had your supervisor discussed with you any concerns about your performance?

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* 12. What is your NTEU chapter?

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* 13. What is your personal email address?

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* 14. What is your personal phone number?