LSU Health - Shreveport  

PM-11 Form A

LA105 v.4          

SECTION 1) EMPLOYEE INFORMATION

To login, use your LSUHSC master account credentials e.g. user name and password.
User Name: (e.g. jdoe2)
Password:
User ID
Last Name: First Name: Middle Name:
Title: Department:
Employee Number:
Fiscal Year (Please Select)  
I have outside employment.