"Authorization to Release Confidential Employee Records" - Alaska

Authorization to Release Confidential Employee Records is a legal document that was released by the Alaska Department of Administration - a government authority operating within Alaska.

Form Details:

  • Released on September 1, 2012;
  • The latest edition currently provided by the Alaska Department of Administration;
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STATE OF ALASKA
AUTHORIZATION TO
RELEASE CONFIDENTIAL
EMPLOYEE RECORDS
I hereby authorize the Division of Personnel & Labor Relations, Employee Records Unit, to release or to approve the
release of confidential records maintained by the State of Alaska, as disclosed on the reverse (page 2 of 2) and as specified
below.
ALL RECORDS (to include, personnel, performance, training, instruction, discipline, pay, attendance)
ONLY THE FOLLOWING RECORDS:
__________________________________________
Record Examples: employment application,
__________________________________________
performance, pay, attendance, medical, job
accommodation, training, travel, work
__________________________________________
injury/illness, etc. (See: reverse (Page 2 of 2))
__________________________________________
__________________________________________
RELEASE TO:
________________________________________
____________________________________________
Name
Phone(s)
________________________________________
____________________________________________
Mailing Address
Email Address
________________________________________
City
________________________________________
State
Zip
ACNOWLEDGEMENT:
I understand, had I not authorized this release, my employee records contain certain confidential
information that is private and protected from disclosure under AS 39.25.080 and Personnel Regulation 2 AAC 07.910. Further, by
signing this authorization, I am releasing the state record holder(s) from all liability that may arise from the information disclosure.
This authorization remains in effect for ninety (90) calendar days from the date signed.
___________________________________________________________
Authorizer: Print Name (First, Last, MI)
_________________
_____________ ___
_______________________________
Employee ID or SSN
Daytime Phone
Email
______________________________________________________________________________________
Authorizer: Signature
Date
Revised 09/2012
Page 1 of 2
Division of Personnel &Labor Relations
STATE OF ALASKA
AUTHORIZATION TO
RELEASE CONFIDENTIAL
EMPLOYEE RECORDS
I hereby authorize the Division of Personnel & Labor Relations, Employee Records Unit, to release or to approve the
release of confidential records maintained by the State of Alaska, as disclosed on the reverse (page 2 of 2) and as specified
below.
ALL RECORDS (to include, personnel, performance, training, instruction, discipline, pay, attendance)
ONLY THE FOLLOWING RECORDS:
__________________________________________
Record Examples: employment application,
__________________________________________
performance, pay, attendance, medical, job
accommodation, training, travel, work
__________________________________________
injury/illness, etc. (See: reverse (Page 2 of 2))
__________________________________________
__________________________________________
RELEASE TO:
________________________________________
____________________________________________
Name
Phone(s)
________________________________________
____________________________________________
Mailing Address
Email Address
________________________________________
City
________________________________________
State
Zip
ACNOWLEDGEMENT:
I understand, had I not authorized this release, my employee records contain certain confidential
information that is private and protected from disclosure under AS 39.25.080 and Personnel Regulation 2 AAC 07.910. Further, by
signing this authorization, I am releasing the state record holder(s) from all liability that may arise from the information disclosure.
This authorization remains in effect for ninety (90) calendar days from the date signed.
___________________________________________________________
Authorizer: Print Name (First, Last, MI)
_________________
_____________ ___
_______________________________
Employee ID or SSN
Daytime Phone
Email
______________________________________________________________________________________
Authorizer: Signature
Date
Revised 09/2012
Page 1 of 2
Division of Personnel &Labor Relations
STATE OF ALASKA
RECOGNITION & LOCATION
OF EMPLOYEE-SPECIFIC
RECORDS
Official personnel and position records for a current or a former state employee of the Executive Branch are permanently on file at the
Division of Personnel & Labor Relations (DOPLR), Employee Records Unit (ERU), Employee Planning and Information Center.
Personnel, position, employee relation, training and development, time and attendance and pay records may also exist at other DOPLR
units or at a Human Resource office or with a supervisor or manager at a particular department or agency. Moreover, employee-
specific records that are necessary to an essential business purpose may exist at other state business locations. Records kept outside
purview of the DOPLR are not subject to direct access, security or control of the division but they are subject to the access, security
and control of applicable state or federal statute, regulations, or administrative policy.
When responding to a written request for access, the ERU will ensure proper authority is in place to release or to approve the release
of confidential record(s) and will make good faith effort to identify all relevant record(s) that exist both within and outside of the
DOPLR.
Following is a prospective list and location of employee-specific records that may be kept outside of the DOPLR. Based on applicable
circumstances, a current or a former employee may not have each record listed.
Type of Record
Location of Record
Employee Travel & Per Diem Record
Administrative Services division of any department or agency.
Human Resource office, specialized recruitment unit or hiring
Recruitment, Application & Hiring Assessment Record
manager at any department or agency.
Pre/Post Employment Background Investigation
Human Resource office or specialized recruitment unit of the
departments of Public Safety, Corrections, Transportation &
Public Facilities or any other state department or agency required
to conduct pre/post-employment background check.
Human Resource office, safety office or a specific program at any
Employee Training Record
department or agency.
Retirement & Employment Benefit Record
Division of Retirement & Benefits (DOA).
Employee Emergency Contacts, Oaths & Affidavits
Division of Finance, Payroll Operations (DOA)
& Wage/Travel/Basic & Optional Insurance Beneficiaries
Workplace Injury or Illness Report &
Division of Risk Management (DOA).
Administrative Services division, Human Resource office or
& Wage/Travel/Basic & Optional Insurance Beneficiaries
safety office at any department or agency.
ADA Workplace Accommodation Record
State ADA Coordinator Office (DOA).
Designated ADA Coordinator at any department or agency.
Human Resource office or specialized recruitment unit at any
department or agency.
Revised 09/2012
Page 2 of 2
Division of Personnel &Labor Relations
Page of 2