Attachment to MEMORANDUM NO. 2003-12
REQUEST FOR INFORMATION
EMPLOYEES RETURNING TO STATE SERVICE
FROM ACTIVE MILITARY SERVICE
Employee Name: ___________________________________________________________
Employing Agency: _________________________________________________________
Agency Contact Person: _____________________________________________________
Date of Return to State Service: _______________________________________________
| SEND TO: | Office of the State Comptroller |
| Policy Services Division | |
| 55 Elm Street, Room 219 | |
| Hartford, Connecticut 06106 | |
| Attn: Christine Grodzki | |
| Fax #: (860) 702-3441 |
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