SPECIAL PAY FOR EXTRAORDINARY ACCOMPLISHMENT REQUEST FORM

SPECIAL PAY FOR EXTRAORDINARY ACCOMPLISHMENT

REQUEST FORM







Name Social Security Number



Department





Source of funding for this adjustment (the account numbers to which this

adjustment will be charged):



Account Number Account %









Amount in Dollars



Justification:









Authorized Signature Date



Senior Officer Signature Date









Please return this form with the Salary Recommendation Sheets to the

Compensation Section, Human Resources, Box 1879.