Cleburne ISD Request for Personnel Records
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1.
Date Requested
*
mm/dd/yyyy
2.
Name
*
Full Legal Name (Last, First, Middle Initial)
3.
Former Name(s)
Only if applicable during your employment with Cleburne ISD
4.
Phone Number
*
5.
Email Address
*
6.
Cleburne ISD Employee ID Number
*
7.
Start Date
*
Employment Start Date or School Year
8.
End Date
Employment End Date or School Year (Former Employees Only)
9.
Documents Requested
*
Information/Documents being requested
Select at least 1.
Service Record
Other, please specify
10.
Reason for Request
*
Reason for Request
*
Resigning (mailed within 30 days or after final paycheck)
Former employee (mailed within 30 days of request)
Current employee (sent to your Cleburne ISD email)
11.
Where do you want us to send the records?
*
The address where your records will be sent
12.
Additional Instructions
13.
Signature
*
Typing your name below represents your electronic signature and confirms your request for Cleburne ISD to release your records to you, the employee/former employee.
14.
Signature Date
*
mm/dd/yyyy