BTOP Quarterly Salary Match

Please complete the form below as it relates to your work performed for BTOP per incident.

All fields are required except the fringe rate.

Contact Information - All fields required except fringe rate

1. First Name:*
2. Last Name:*
3. Email:*
4. Date of Work:* [format: mm/dd/yyyy]
5. Description/Program:*
6. Total Hours:* [per hour basis; ex. use decimals. 1.0 or .5; Please only write numbers, no words]]
7. Salary Rate:* [ex. $19.75, use decimals, out two places]
8. Fringe Rate: [not required; ex. 30%]