Position Title: ______________________________________________ Date: _________________________ email address: _______________________________________ Telephone Number: ____________________ Start Date End Date Position Pay Rate Time Earnings CalPERS use (m/d/y) (m/d/y) only (Hourly/Daily/ Worked Monthly) (In Hours)
Position Title: ______________________________________________ Date: _________________________ email address: _______________________________________ Telephone Number: ____________________ Start Date (m/d/y) End Date (m/d/y) Position Pay Rate (Hourly/Daily/ Monthly) Time Worked (In Hours) Earnings CalPERS use only
PERSMEM1344.docx