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Use this form to submit your appeal EDUCATION AND EXPERIENCE APPEAL FORM Do Not Write Your Name Anywhere On This Form. Print All Required Information In Black Or Blue Ink. Social Security Number - - Exam Title Exam Number SECTION 1 EMPLOYMENT I am appealing my disqualification for not indicating that I possess the minimum employment qualification requirements. Qualifying Employment Job Title Name of Employer Address of Employer Nature of Employer s Business Number of Hours Worked per Week Dates of Employment - From / To / Total Time / Month Year Presently Employed Month s Year s Qualifying Experience Describe each of your duties separately with percentages Required for Rating. Total Time Spent Performing These Duties Time If you need more space attach additional Education and Experience Appeal Forms. Be sure to include your social security number the exam title and number on each attached sheet. SECTION 2 FOREIGN EDUCATION am having an evaluation of my foreign education submitted directly to MTA New York City Transit by an approved evaluation service. SECTION 3 EDUCATION degree. The diploma or degree that I possess that I need to qualify is only check one box GED High School Associates Degree Vocational High School Bachelors Degree Trade School Masters Degree I do not have a diploma or degree Dates of attendance From / To / Date of Graduation / Name of Educational Institution USA Foreign Address of Institution Section 3A Vocational High School/Trade School Specialty Number of hours you completed in specialty Section 3B College/University Major Number of Credits Completed in Major Total Number of Credits Completed Title of Degree SECTION 4 ERROR IN EVALUATION If you believe that we have made a mistake in the way we evaluated the information you provided to us you should use the box below to notify us of our mistake. Social Security Number - - Exam Title Exam Number SECTION 1 EMPLOYMENT I am appealing my disqualification for not indicating that I possess the minimum employment qualification requirements. Qualifying Employment Job Title Name of Employer Address of Employer Nature of Employer s Business Number of Hours Worked per Week Dates of Employment - From / To / Total Time / Month Year Presently Employed Month s Year s Qualifying Experience Describe each of your duties separately with percentages Required for Rating. Qualifying Employment Job Title Name of Employer Address of Employer Nature of Employer s Business Number of Hours Worked per Week Dates of Employment - From / To / Total Time / Month Year Presently Employed Month s Year s Qualifying Experience Describe each of your duties separately with percentages Required for Rating. Total Time Spent Performing These Duties Time If you need more space attach additional Education and Experience Appeal Forms. Total Time Spent Performing These Duties Time If you need more space attach additional Education and Experience Appeal Forms. Be sure to include your social security number the exam title and number on each attached sheet. SECTION 2 FOREIGN EDUCATION am having an evaluation of my foreign education submitted directly to MTA New York City Transit by an approved evaluation service. .

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