ICE Directive 1004.1, Creditable Service for Annual Leave Accrual Form for ICE Directive 1004.1

Employer: Title: From (Month, Yr): To (Month, Yr): Description of Related Duties: Employer: Title: From (Month, Yr): To (Month, Yr): Description of Related Duties: Employer: Title: From (Month, Yr): To (Month, Yr): Description of Related Duties: Creditable Service Com leted b HR Yrs: Mo: Creditable Service by HR Cora leted Yrs: Mo: Creditable Service Com leted by HR Yrs: Mo: Agency Certification: I certify that the information on this form accurately reflects verified information contained in the application records in the custody of this agency and that the non-federal service reflected is creditable in determining the employee's annual leave accrual rate. Total Recommended Leave Accrual Service: Years: Months: Human Resources Specialist Agency Decision: Approved q Not Approved Director, Office of Human Capital Date Date REL0000021288