Revised 11/7/14
Sandhills Community College
Official Personnel File Access Request Form
To schedule an appointment to view or request a copy of your official personnel file please complete
each appropriate section of this form and send via email, fax or campus mail to the Human Resources
Department.
_________________________
Date Submitted
__________________________________________ ______________________________________
First Name Last Name
__________________________________________ __________________________________
Email Address Phone
__________________________________________ __________________________________
Department Job Title
I would like to request an appointment to view my Official Personnel file in the presence of the
Human Resources Director, or their designee, at a location, date and time that is mutually
agreeable. The last date I reviewed my file was ________________.
Completed by HR
Request received by: ________________________________ Date:_________________
Appointment Scheduled for:
Date: _______________________ Time:_______________________
File review completed by:___________________________________ Date:_________________
I would like to request a photocopy of
□ my Official Personnel File
□ documents in my personnel file listed below:
________________________________________________________________________
(after a copy of your file has been made, HR will contact you when it is available to pick up.)
Completed by HR
File copy completed by: ________________________________ Date: ____________________
Employee Signature of Receipt: ________________________________ Date: ______________
View my Medical File
Completed by HR
Request received by: ________________________________ Date:_________________
Appointment Scheduled for:
Date: _______________________ Time:_______________________
File review completed by:___________________________________ Date:_________________
Obtain a photocopy of my Medical File
Completed by HR
File copy completed by: ________________________________ Date: ____________________
Employee Signature of Receipt: ________________________________ Date: ______________
Employee Signature: ________________________________________ Date: _______________
__________________________________________________________ Date: _______________
Signature of HR Director or designee
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit