Form Vl775 - Employee Records Request Form
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1
2Please return to:
VL775
DECD People and Culture - Operations
Updated 12/16
Email:
DECD.HRSystems@sa.gov.au
Courier R11/10
GPO Box 152
Adelaide SA 5001
Ph: (08) 8226 1356
Fax: (08) 8124 4631
EMPLOYEE RECORDS REQUEST FORM
An Employee Records Request Form is to be used by current or past employees or applicants with DECD who require access to their personal
records.
For details of your DECD work history please refer to
VL778 Statement of Service Request
Personal records can be viewed or copied as per the below request. Past employees will be required to provide proof of identity. Information will
only be released to the address or contact details held within the DECD employee database.
Once completed, email the form to the People and Culture - Operations (email: DECD.HRSystems@sa.gov.au).
IMPORTANT requests to view records by a Third Party (anyone other than the owner) will need to be made in writing to the Freedom of
Information Office. Webpage:
About the Department: Freedom of Information (FOI)
Email Address:
DECD.foi@sa.gov.au
or Legislation and
Legal Services Unit Email Address: DECD.legalrequests@sa.gov.au.
Section 1: EMPLOYEE DETAILS
Family Name
Given Name(s)
Previous Surname
Date of Birth
(If applicable)
ID Numbers
Please list all employee ID numbers provided by DECD.
Section 2: CONTACT DETAILS FOR SENDING EMPLOYEE RECORD
Address
Contact Phone
Postcode
Number
E-mail
Section 3: GENERAL INFORMATION / EMPLOYMENT HISTORY / TYPE OF EMPLOYMENT
*** Please provide an indication of ANY service with DECD:
Indicate which employment sector(s) is /are appropriate to you by placing an X in one or more boxes.
DECD
DECD
Employment within:
Schooling Sector
Preschool Sector
Corporate
Families SA
Type of employment
Termination Date(s)
Commencement Date(s)
(teacher, ancillary, corporate)
(If applicable)
Documents Requested:
Please select appropriate box:
I require copies of the documents
I wish to inspect the documents
Section 4: DECLARATION
By placing an X in the box on the left, I declare to the best of my knowledge that the information I have provided on this
form is true and correct.
Date
Requester Signature
Requester Employee Name
OFFICE USE ONLY:
Current Employee
Past Employee
Release Authorised by:
Contact details
Signature:
ID verified
verified
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Parent category: Legal