TELECOMMUNICATIONS ON-LINE EMPLOYEE DIRECTORY

 

Please complete this form for the all Health Center staff. It’s purpose is for the Telecommunications On-Line-Directory. All information will be kept confidential.

Please return to Regina Devino at devino@adp.UCH.edu or fax to 679-1991, MC-5360.
  • Ms.
  • Mr.
  • Dr.
  • last
  • first

middle initial

clinic #

  
  • work #
     

beeper #

    
  • department
 
  • MAIL CODE
  • building
  • floor
  • room
 

payroll title

e-mail address

  
   

fax #

home #

( )

home address (optional)

notes
 
 
 
 
 
 

 

auth code

cell phone

calling card