Comptroller General’s Office
Form P-4 (Rev. 2/17)
Employee Information and
Voluntary Recurring Deductions
Employee Information
New Request ________
Change Request ___________
Personal Information (Completed by Employee)
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
ZIP Code
Home Phone:
Alternate Phone:
Email
Job Information (Completed by Employer)
Title:
Personnel No:
Agency Name
Supervisor:
and No:
Work Location:
Email:
Work Phone:
Cell Phone:
Emergency Contact Information (Completed by Employee)
Full Name:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
ZIP Code
Primary Phone:
Alternate Phone:
Relationship: