Employee Assistance Request Form
We're here to help!

If you are a Title 32 dual-status (DS) technician or Title 5 employee of the National Guard and are in need of assistance, please fill out this form. A representative will contact you within 24-hours to discuss your concerns and your possible options.


This form seeks information regarding your request for assistance. This is not a guarantee of representation. Representation is based on the merits of your case and not on membership status. In certain cases, non-members seeking representation may be required to enroll as dues-paying members prior to representation and/or may be responsible for some or all of the costs incurred by the Union during the course of representation.

Privacy Notice *
Information collected is for representational purposes and is not shared with any party or entity that does not have a need to know: http://www.local1776.org/liuna_ngc_local_1776_privacy_policy.html
Type of Request *
Please select the option that best describes your request.
Never submit passwords through Google Forms.
This form was created inside of LIUNA Local 1776. Report Abuse - Terms of Service - Additional Terms