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HRSA Electronic Handbooks

Request New Account - Enter Employee Information

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Employee Information

Salutation
select
Required Field:  
  (max 30 characters)
  (max 1 character)
Required Field:  
  (max 30 characters)
Star (Required Field):
  (10 digit number from employee PIV card)
 
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Contact Address

Required Field:  
 
Required Field:  
   -    Ext. 
   - 
 
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Employee Details

Required Field:  
If Contractor or Other, Specify Organization Name     (max 100 characters)
Required Field:  
If Temporary, Specify Departure Date 
RadDatePicker
RadDatePicker
Open the calendar popup.
Required Field:  
If Field Office or Other, Specify Work Location    (max 100 characters)
Star (Required Field): Office Help Link Change of bureau/office will prompt an email notification to the Access Authorizing Officers (AAOs) of the current and new office/bureau.

Sub-Unit (if applicable)
 
 

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