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MEMORANDUM FOR DoDDS-Europe, Human Resources Office, Wiesbaden

Subject: Request for VERA and/or VSIP I request that I be approved for a specific offer of VERA and/or VSIP. I understand that I must occupy a position that if vacated would result in the placement of an employee who would otherwise be separated due to a Reduction in Force. I further understand that I must separate no later than June 30, 2013, to be eligible for this offer. PRINT NAME: ____________________________________________________________________________ CURRENT POSITION TITLE: _______________________________________________________________ CURRENT POSITION SERIES AND GRADE: __________________________________________________ CURRENT DUTY LOCATION: ______________________________________________________________ HAVE YOU EVER RECEIVED SEVERANCE PAY AS A FEDERAL EMPLOYEE? _______NO_______YES IF YES PROVIDE THE DATE________________ HAVE YOU EVER RECEIVED VSIP? _______NO_______YES IF YES, PROVIDE THE DATE_______________ _____________________________________________________ _____________________________ Signature Date

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