02/11/13
Request to View Personnel Records
(Labor Code 1198.5)
Date:
Employee (Current/Former) Name:
Company Name:
I request to inspect/receive a copy of (circle one or both) my personnel records.
I authorize (authorized representative) to inspect/receive (circle
one or both) a copy of my personnel records.
I understand I will be charged the actual cost of copies and postal expenses. I further understand that only those records required by
law will be made available to inspect/copy.
Employee Signature Date
Employer Response to Request to View Personnel Records
Date:
Employee Name:
In response to your request to view/copy personnel records:
You/Your representative (circle one) is scheduled for an appointment with
Name
on at for the purpose of reviewing your personnel records.
Date Time
Note that during the inspection nothing may be removed from or added to your personnel records.
A copy of your personnel records will be made available to you/your representative (circle one). Contact
to make arrangements for receipt of the copy.
Name
You will be responsible for copying and/or postal costs at the rate of per page.
You/Your representative’s request to inspect/receive a copy of your personnel records has been denied for the following reason(s):
California Lutheran University is only required to comply with one request per year by a former employee to inspect or receive a
copy of his or her personnel records. The most recent request was completed on .
California Lutheran University is not required to comply with more than fifty (50) requests to inspect or receive personnel request
filed by an employee representative(s) in one calendar month.
California Lutheran University is not required to comply with a request to inspect or copy personnel records while you have a
pending lawsuit against California Lutheran University relating to a personnel matter.
Human Resources Representative Date
