Years of Service Correction Form

Years of Service Correction Form

Complete all fields below to request a review of your years of service. Please allow 7-10 business days for processing from the date of submission. You will be contacted if additional information is needed. For any questions or assistance regarding this form, please email AskHR@virginia.edu and enter Years of Service Correction in the subject line.

If you are a UPG team member, please contact Samantha Strong at kbx4dh@uvahealth.org to request corrections to your years of service.

Thank you,
The Academic & UVA Health Rewards & Recognition Teams

Your Full Name

Nickname

Have you been known by any other name during your time at UVA? If so, what is it? (Please include the Full Name)

Your UVA Email Address

Your Employee Type

Academic Staff
School of Medicine Team Member
School of Nursing Team Member
Medical Center Team Member

Reason for Years of Service Correction (Please provide details)

Have you been recognized for service at UVA before?

Yes
No

When were you recognized last for service at UVA? (Please provide details)

Is there anything else we should know before research begins?

Today's Date: