1. Requesting Organization & Requestor Information
An automated acknowledgment email will be sent to this address.
2. Former Employee Information
Enter only the final 4 digits (e.g., 1234) for record matching.
Employee Release & Privacy Protocol: Upon submitting this form, an automated confirmation email will be sent to the requestor email address provided above, and an electronic authorization request will be dispatched to the former employee on file to approve the release of their employment records.

Verification Request Submitted & Acknowledgment Dispatched

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