HR Performance Records Request

HR PERFORMANCE RECORDS REQUEST

Use this form to request access to performance-related personnel records maintained by Human Resources. Complete all applicable sections. Incomplete requests may delay processing. The requester certifies that the information provided is accurate and that the requester is authorized to receive the requested records.

Personal Information (Requester)

Employee/Subject of Records (if different)

Position Information

Records Requested

Select the categories of performance records requested. Check all that apply.

Performance evaluations (annual, interim)

Performance improvement plans (PIPs)

Disciplinary actions, warnings, or write-ups

Attendance records related to performance

Training, development, and coaching records

Promotion and role-change history

Salary history and compensation actions

Termination records and separation documentation

From:    To:

Purpose and Delivery

Delivery method (select one or more):

Pickup in person

Mail to address provided above

Email to address provided above (may be redacted)

Secure electronic portal (if available)

Identification and Authorization

To process this request, the requester must provide proof of identity. If requesting on behalf of the employee, attach documentation establishing authority to request records.

I have attached power of attorney, authorization letter, or other documentation authorizing release to a third party

Employment History (for record context)

Employer 1

Dates employed: From To

Employer 2

Dates employed: From To

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures and Acknowledgements

By submitting this request, the requester acknowledges the following:

1. Human Resources will release only records maintained in personnel files and may redact or withhold information required to be kept confidential by law, or that pertains to other employees' privacy interests.

2. The organization may charge reasonable copying, redaction, or processing fees. The requester will be notified of any fees prior to fulfillment and must pay fees before records are released.

3. This request does not alter or waive any applicable retention schedule, legal hold, or limitation on disclosure imposed by policy or law.

4. At-Will Employment: Nothing in this request alters the at-will employment relationship between the organization and any employee, where applicable.

5. Equal Employment Opportunity: The organization is an equal opportunity employer. Requests for records will be processed without regard to protected characteristics.

I acknowledge that I have read and understand the statements above.

I acknowledge and agree

Authorization and Certification

I certify under penalty of perjury that the information provided in this request is true and complete. I authorize Human Resources and authorized representatives to locate, compile, copy and release the records specified above to the requester or the authorized third party named in this form. I release the organization and its agents from liability for disclosure of records made in good faith pursuant to this authorization.

I understand I may revoke this authorization in writing at any time, except to the extent that action has already been taken in reliance on it. Revocation does not affect disclosures already made in reliance on this authorization.

I certify and authorize as stated above

Authorization to Contact and Background Checks

For the purpose of verifying employment history or related matters, I authorize HR to contact prior employers and references listed. I understand that authorization for background checks may be required and separate consent will be requested if applicable.

I authorize HR to contact prior employers and references as necessary

Signature

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