Employee Request for Records Upon Resignation

Please complete the form below. Required fields marked with an asterisk *

Employee Request for Records Upon Resignation

Please fill in all sections

Request Date*

Answer required for "Request Date"

Campus Last Worked:*

Answer required for "Campus Last Worked:"

Records Request for:

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Previous or Maiden Name Records Filed Under:

Number Required

Social Security Number

Answer required for "Social Security Number"

Email Address

Answer required for "Email Address"

Requester Phone number*

Number Required

Records Requested

(Please select options below for records being requested)

Answer required for "Records Requested"

Original

Copy

Service Record

Transcript

Certificate

Diploma

Other:

*Requester Electronic Signature*

Full Name

Answer required for "*Requester Electronic Signature"

Records Distribution (Please select options below for records being requested)

Records will be mailed to requestor by the Robstown ISD Office of Human Resources at the address shown below:

Answer required for "Records will be mailed to requestor by the Robstown ISD Office of Human Resources at the address shown below:"

Yes

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Records will be picked up by requester at the Robstown ISD Office of Human Resources:*

Answer required for "Records will be picked up by requester at the Robstown ISD Office of Human Resources:"

Yes

Electronic Signature of Requester*

Full Name

Answer required for "Electronic Signature of Requester"

Request Date*

Answer required for "Request Date"

Mail records to my next employing district:

Answer required for "Mail records to my next employing district:"

Yes

Address

Attention

Answer required for "Attention"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Phone Number

Number Required

Please fix the highlighted areas below before submitting.

Employee Request for Records Upon Resignation