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

Campus Last Worked:*

Answer Required

Records Request for:

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Previous or Maiden Name Records Filed Under:

Number Required

Social Security Number

Answer Required

Email Address

Answer Required

Requester Phone number*

Number Required

Records Requested

(Please select options below for records being requested)

Answer Required

Original

Copy

Service Record

Transcript

Certificate

Diploma

Other:

*Requester Electronic Signature*

Full Name

Answer Required

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

Yes

Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

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

Answer Required

Yes

Electronic Signature of Requester*

Full Name

Answer Required

Request Date*

Answer Required

Mail records to my next employing district:

Answer Required

Yes

Address

Attention

Answer Required

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Phone Number

Number Required

Please fix the highlighted areas below before submitting.

Employee Request for Records Upon Resignation