Employee:

Date Requested:

Tax I.D. No:

Department/Location:

Work Phone:

I request an appointment with the Personnel Department for the purpose of inspecting my personnel file.

I previously reviewed my file

________________________ Date:

Signature

File review appointment scheduled for

Date: Time: ________ Am/Pm

Location:

Date File Review Completed:

Employee comments regarding information in the personnel file:

__________________________ Date:

Personnel Representative

__________________________ Date:

Employee Signature

Employee should complete top section of request form and forward to the Personnel Department. Place one completed copy of this form into personnel file upon completion of review.