REQUEST FOR O.P.S APOINTMENT EXTENSION – DEPARTMENT OF ECONOMIC OPPORTUNITY
TO:

From:

Extension of OPS Appointment is requested as indicated below:
1. Process Area:	2. Process Unit:	3. Funding Source:
4. Justification:
5. Extension: In the cumulative hours worked column, indicate the total hours worked within AWI as of the date of request. In the authorization requested column, indicate the total number of hours each employee is to be authorized.
Name	Social Security Number	Office Location	Cost Center	Position Number	EOD Date	Cumulative Hours Worked	Extension Requested	Authorization Requested
6. Requested By:

Authorized Signature:
Title:	Date:
For HRM Office Use Only
7. AWI Action (HRM Use ONLY)
RECOMMENDED	DISAPPROVED
Authorized Signature:
Title:
Date:
8. Final AWI Action
APPROVED	DISAPPROVED
Authorized Signature:
Title:
Date:

DEO Form HRM 20-A ( 08/11)

REQUEST FOR O

J0JEM

1999-11-15

mcgillj

FDLES J&B OIT