Online Form

BTU MEMBER LAYOFF FORM 2009

Union leaders would like to express their support for you during this difficult time. If you have received official written notification from the district that you may be laid off, please fill out the form below. The BTU will keep all information you provide confidential. Thank you.

NOTE: Please use upper and lower case letters. DO NOT USE ALL CAPS OR ALL LOWER CASE LETTERS.

* POSITION:

BTU - Education Professionals (Broward Instructional Staff)
BTU - Technical Support Professionals (Broward Technical Support Staff)
BTU - Education Support Professionals (Broward Support Staff)
BTU - Charter School Professionals (Pines Charter Instructional Staff)
Other

* FIRST NAME:

* LAST NAME:

* HOME STREET ADDRESS:

* HOME CITY:

* HOME ZIP CODE:

* CELL PHONE NUMBER:

* HOME PHONE NUMBER:

* CAB E-MAIL ADDRESS:

NOTE: Please double check your CAB e-mail addresss to make sure it follows the district's standard format -- john.doe@browardschools.com

PRIVATE E-MAIL ADDRESS:

NOTE: Please double check your PRIVATE e-mail address to make certain it is a valid address -- johnd@hotmail.com

* SCHOOL / WORKSITE FOR 2008-2009 YEAR:

* SALARY SCHEDULE STEP FOR 2008-2009 SCHOOL YEAR:

* We are in desperate need of employees who are willing to speak out for members. If you are willing to be interviewed by the media about being laid off please check "yes" below:

YES
NO

Thank you for completing this questionnaire. Please do not forget to click the submit button below.

* Would you like a BTU staff member to contact you at this time?

YES
NO