Robstown Independent School District

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Employee Records Request

Employee ID or SSN*

Answer required for "Employee ID or SSN"

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Campus/Department*

Answer required for "Campus/Department"

Position/Job Title

Answer required for "Position/Job Title"

Employee Email

Answer required for "Employee Email"

Employee Phone

Number Required

GENERAL RELEASE

I hereby authorize Robstown Independent School District and its duly authorized representatives to release information concerning or relating to my employment with the school district. This employment information, both oral and written, may include material contained in my personnel file and evaluative statements and judgments from my former supervisors. This employment information includes, for example, academic, salary, achievement, performance, attendance, personal history, disciplinary records, and employment information. I hereby release any individual providing reference or employment information under this authorization, including record custodians, from any and all liability for damages of whatever kind or nature that may at any time result to me on account of compliance, or any attempts to comply, with this authorization.

Signature*

Signature Required

ONLY CONTINUE IF YOU ARE REQUESTING records be sent to a new district.

NEW DISTRICT INFORMATION

Please complete the remaining sections of this form with your NEW DISTRICT forwarding information. Requests will be processed in the order they are received.

District Name

Answer required for "District Name"

Mailing Address

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City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

HR Contact Name

Answer required for "HR Contact Name"

HR Phone Number

Number Required

HR Contact Email

Answer required for "HR Contact Email"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"