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DOMINICK S. PANGALLO MAYOR LISA B. CAMMARATA DIRECTOR OF HUMAN RESOURCES CITY OF SALEM MASSACHUSETTS HUMAN RESOURCES 98 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 TEL. [PHONE REDACTED] REQUEST FOR VERIFICATION OF EMPLOYMENT FOR RETIREMENT BUYBACK PURPOSES For us to provide you with accurate information we must have the EXACT months, years and departments in which you worked for the City of Salem. Without this information, we cannot locate this payroll information for you. Note: if you participated in the CETA program, please note we do NOT have those payroll records. Name: Name at time of employment (if different): Months and years and departments that you worked in for the City of Salem: Job Title/Position (if more than one, please be specific to the department and time frames you stated above): Address where information is to be sent: Signature and date: Email address and phone number: OFFICE USE ONLY: Completed by and date: Comments: