SPECIAL PAY FOR EXTRAORDINARY ACCOMPLISHMENT REQUEST FORM by stevencampbell

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									          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.

								
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