Request to Inspect Personnel File

1. Employee Name:	Social Security Number:	Date of This Request:
Department/Location:		Work Telephone or Extension:
I request an appointment with the HR Department to inspect my personnel file. The last date I reviewed my file was _________________________. Signature: _________________________________________________

2. Appointment Schedule:	_______________ Date	_______________ Time
__________________________ Place	File review completed (Date): _________________________

3. Employee comments regarding accuracy of information in this file. _______________________
______________________________________________________________________________
_______________________________________ Personnel Representative Signature	_______________________________________ Employee Signature