NJEA Consultant Survey Name First Last Date Consultant Position (Check all that apply) Communications Government Relations Organizational Development PDII PDII - ACCESS PDII - TLA Pension UniServ Northwest UniServ Northeast UniServ Central UniServ South Regional Office (UniServ Only)Will you be a full-time public school or county college employee as of next September 1? Yes No I am retired If yes, what is your local association?If yes, what is your job title?If retired, what was your date of retirement? Are you a unified member of NJEA, NEA and your county and local associations or, for retirees, are you a member of NJREA, NEA-R and your county retiree association? Yes No What times of day are you unavailable to take assignments (including your regular work hours)?Do you currently serve on any state commission or board or hold any other elected or appointed political position? Yes No If yes, please describe.Will any of your responsibilities present a conflict of interest with your employment as a part-time consultant? Yes No If yes, please explain.
