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Service Record Request Form
Please allow a minimum of 30 working days from last date of employment for preparation.
Allow additional time during the months of May, June, July & August.
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* Indicates required question
Email Address
*
Your answer
Last Name (Name while Employed)
*
Your answer
First Name
*
Your answer
Employee Number
Your answer
Phone Number
*
Your answer
Campus/Department
*
Your answer
Currently Employed with LISD
*
Yes
No
Name and Address to be Mailed to:
*
Your answer
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