Form HR-55 "Request for Appellant Official Personnel File" - Nevada

Form HR-55 is a Nevada Department of Administration form also known as the "Request For Appellant Official Personnel File". The latest edition of the form was released in September 1, 2015 and is available for digital filing.

Download a PDF version of the Form HR-55 down below or find it on Nevada Department of Administration Forms website.

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Download Form HR-55 "Request for Appellant Official Personnel File" - Nevada

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REQUEST FOR APPELLANT OFFICIAL PERSONNEL FILE
This form is to be used by an appellant or his or her authorized representative and/or a State Executive
Branch agency representative to request the official personnel file of an employee or former employee
who has appealed his or her suspension, demotion, termination, involuntary transfer, or to appeal an
action that he or she believes was the result of a “Whistleblower” complaint.
Please complete and sign the form and return it to Division of Human Resource Management, Central
Records via email at DHRM-CentralRecords@admin.nv.gov or by fax at (775) 687-9085 and allow
at least five business days to process the request. The hard copy personnel file will be marked
confidential and sent to the address listed below or held for pickup.
Requestor Contact Information/Affirmation
Appellant/Appellant’s Authorized Representative
Executive Branch Department/Agency
Requested By:
Contact Name (if other than appellant):
Contact Phone:
Contact Email:
I affirm I am the appellant or a representative designated to act on behalf of the appellant or a State
Executive Branch agency.
Signature:
Date:
Official Personnel Files Requested
Appellant Name:
Appellant Employee I.D. Number:
Case Number (if known):
Hearing Date (if known):
Description of Files Requested (e.g. performance evaluations, disciplinary, entire file; include date
range if applicable):
Return Service Requested – Release of Documents
USPS Certified Mail
FedEx: FedEx Account Number
Pickup by appellant OR by (name of
individual):
on behalf of agency/department or on behalf of appellant’s authorized representative (verification by
photo I.D. required upon pickup)
Return Address:
Division of Human Resource Management – Section for Central Records Use
Date Received:
Assigned To:
Date Request Completed:
Pickup Signature Verification:
Date:
HR-55
9/2015
REQUEST FOR APPELLANT OFFICIAL PERSONNEL FILE
This form is to be used by an appellant or his or her authorized representative and/or a State Executive
Branch agency representative to request the official personnel file of an employee or former employee
who has appealed his or her suspension, demotion, termination, involuntary transfer, or to appeal an
action that he or she believes was the result of a “Whistleblower” complaint.
Please complete and sign the form and return it to Division of Human Resource Management, Central
Records via email at DHRM-CentralRecords@admin.nv.gov or by fax at (775) 687-9085 and allow
at least five business days to process the request. The hard copy personnel file will be marked
confidential and sent to the address listed below or held for pickup.
Requestor Contact Information/Affirmation
Appellant/Appellant’s Authorized Representative
Executive Branch Department/Agency
Requested By:
Contact Name (if other than appellant):
Contact Phone:
Contact Email:
I affirm I am the appellant or a representative designated to act on behalf of the appellant or a State
Executive Branch agency.
Signature:
Date:
Official Personnel Files Requested
Appellant Name:
Appellant Employee I.D. Number:
Case Number (if known):
Hearing Date (if known):
Description of Files Requested (e.g. performance evaluations, disciplinary, entire file; include date
range if applicable):
Return Service Requested – Release of Documents
USPS Certified Mail
FedEx: FedEx Account Number
Pickup by appellant OR by (name of
individual):
on behalf of agency/department or on behalf of appellant’s authorized representative (verification by
photo I.D. required upon pickup)
Return Address:
Division of Human Resource Management – Section for Central Records Use
Date Received:
Assigned To:
Date Request Completed:
Pickup Signature Verification:
Date:
HR-55
9/2015
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