More Information:  Employee Responsibilities

Checking Codes| Refund Deductions | Tracking Coverage

WORK HISTORY SUMMARY
(Sample Only)

Name: ___________________________________ DOB: ______________________________
SSN: ________________________ Retirement Code: ___________________

DATES

 AGENCY/BUREAU LOCATION TITLE, SERIES, GRADE  POSITION NUMBER SPECIAL RETIREMENT COVERAGE
From  To 
           
           
           
           
           

The above service history is based on the employee's Official Personnel Folder.

 Signature of Personnel Officer or Delegated Authority:                                                                   Date:                              

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Revised 05/03/2002

 

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