VA0857a, WRITTEN CONFIRMATION OF REQUEST FOR …

1. NAME OF EMPLOYEE. WRITTEN CONFIRMATION OF REQUEST FOR ACCOMMODATION. VA FORM MAY 2013. 2. PHONE NUMBER OF EMPLOYEE . 4. TODAY'S DATE (Include Area Code) 9. ACCOMMODATION REQUESTED (Be as specific as possible) 0857A. 10. REASON FOR REQUEST. Employees should give this form to their immediate supervisor or the LRAC. 11. ................
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