ACCRETION REQUEST
First Name
*
Last Name
*
Personal Email
*
example@example.com
Work Email
*
example@example.com
Phone No.
*
Format: (000) 000-0000.
Agency Name
Please Select
ACERA
AHS
ALAMEDA COUNTY HEALTH
ASSESSOR'S OFFICE
AUDITOR-CONTROLLER
BEHAVIORAL HEALTH CARE SERVICES
CAO
CHILD SUPPORT SERVICES DEPT
COMMUNITY DEVELOPMENT AGENCY
COURTS
DISTRICT ATTORNEY
ENVIRONMENTAL HEALTH
GENERAL SERVICES AGENCY
HUMAN RESOURCES SERVICES DEPT
IT DEPARTMENT
LIBRARY
PROBATION DEPT
PUBLIC DEFENDER
PUBLIC HEALTH
PUBLIC WORKS AGENCY
REGISTRAR OF VOTERS
SHERIFF'S OFFICE
SOCIAL SERVICES AGENCY
TREASURER
WORKFORCE DEVELOPMENT BOARD
ZONE 7 WATER AGENCY
OTHER
Your Classification
*
Employee ID No.
*
Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: