Free VA Form VA3486a - Senior Executive Service Performance Rating/Award Authorization - Federal

SENIOR EXECUTIVE SERVICE PERFORMANCE RATING/AWARD AUTHORIZATION
RATING PERIOD
FROM TO

1. NAME OF EXECUTIVE (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER (Last four-digits only)

3. PAY LEVEL AND PAYABLE SALARY

4. TITLE AND LOCATION OF POSITION(S) UPON WHICH RATING IS BASED

5. TITLE AND LOCATION OF CURRENT POSITION (If different from above)

6. STATION NUMBER

7. ORGANIZATION COST CODE

8. FINAL RATING AND AWARD
A. THE PERFORMANCE RATING FOR THIS EXECUTIVE IS

B. A PERFORMANCE AWARD IS APPROVED IN THE AMOUNT OF

C. NO PERFORMANCE AWARD AUTHORIZED

$
9. SIGNATURE OF AUTHORIZING OFFICIAL 10. DATE

VA FORM DEC 1994

3486a

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