Complete the following:

Name
Employee #
Birthdate
Department
Phone
Email
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I would like to request the following:

Record of Earnings
Pay Check Stub
Direct Deposit Advice

Enter payday or year needed in the box below:

Please send the records requested to:

Permanent address of record
Campus address of record
Don't mail it, I will pick it up* and show ID
Mail to this campus address: 
Mail to this off campus address: 
Fax to: 

Comments:

*Note:  Records requested can be picked up at the Payroll Services window at 10920 Wilshire Blvd, Suite 620.  Requests for records will take about a week to process.   We will call you when the records are ready for pick up at the Payroll Services window.

Once you click on the Send Email form button below, a confirmation form will appear.  We suggest that you print it for your records.  If you do not see a confirmation form in your web browser or receive an error message, please call (310) 825-1089 to request the records by phone.

For office use only.
Do not put anything in this field.