RECORDS REQUEST FORM

RECORDS REQUEST FORM
If you have questions about this form or this process, please call Kim Dailey at 817-563-8003
Name*
Other Name(s) Records May Be Listed Under
Social Security # (last four digits)*
Employee ID Number
Address*
City*
State*
Zip Code*
Email Address*
example@example.com
Home Phone
Cell Phone*
Employment Status*

Current EmployeeFormer Employee
Assignment*
Original Hire Date*

MonthDayYear
Date
Separation Date*

MonthDayYear
Date
CHECK THE DOCUMENTS REQUESTED*

Service Records:Transcripts:
Copies will be provided for current employees. Originals can only be surrendered upon separation from the district and after sick days are recorded in payroll.

Please note: You must print copies of your T-TESS appraisals from DMAC before being exited from the system.
PLEASE CHECK ONE OF THE FOLLOWING:*

Mail records to the address above.I will pick up records at the Administration Office. You will be notified when the requested records are ready. Records not picked up within 30 days will be returned to the file and you will have to submit the request againEmail records
Email records to
example@example.com
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: