Employee Records Request

1.	First Name*

2.	Last Name*

3.	Prior First Name*

4.	Prior Last Name*

5.	Last Four of Social*

6.	Phone*

7.	Email Address*

8.	Delivery Method*
	--Please Select--Mail to AddressPick Up

9.	Delivery Method If you choose to pick up your records we will notify you by phone when they are available. Please fill out the address form if you choose to receive mail to address.*
	Street Address   Address Line 2   City   State   Zip Code Address Information

10.	Type of Employee*
	Current Employee    Substitute    Former Employee

11.	Documents Requested*
	Service Records    Transcripts    Substitute Service Records    Other Documents

12.	If 'Other Documents' please explain: