personnel action Request Form Retro Pay "*" indicates required fields Requestor Email* Select your Region VP* Carlos Rivera Eric Wheeler Jaime Restrepo Edita Gargovic Elgar Quijandria Effective Date* MM slash DD slash YYYY Section 1: Employee Information Employee Name* First Middle Last Employee ID #* Section 2: Assignment Information Home Department*Job Number*Date & Hours*DateAmount of Hours Add Remove*if multiple days are being requested, please select the "+" sign for more entries. Reason*Signature* Δ
