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Get 2012 Flexible Reimbursement Accounts Enrollment Form - Brandeis

Oyee Information Employee Name Department Mailstop 12 31 Date of Hire / / Extension Employee ID Staff Faculty Weekly (48 pay periods/year) Payroll Mode: Semi-monthly (24 pay periods/year) Will you be unpaid over any of the Summer months, scheduled to work less than 52 weeks.

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