Employee Personnel Records Transmittal by 9ZdMKlU

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									                                                         Employee Personnel Records Transmittal
Complete this form when an employee transfers to another agency or sub-agency. The losing agency completes this form and forwards to the gaining agency.
Keep a copy of this form for your records.

Employee Last Name:                                        First Name:                                Middle Name:


Personnel Number:                                          Agency:                                    Last Date Carried:


FMLA used in previous 12 months? Yes                No
Provide details (if necessary):


Comments:



Losing Agency Payroll Contact -
Payroll Contact’s Name:                Job Title:                        Email:                    Phone:                      Mail Stop/Address


Preparer -
Preparer’s Name:                       Job Title:                        Email:                    Phone:                      Date Prepared:


To -
Agency/Division:                       Contact Name:                     Email:                    Phone:                      Mail Stop/Address:




                   OFM 12-048 (11/23/11) Employee Personnel Records Transmittal

								
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