Service Record Request Form

Required

Clear Creek ISD will prepare one original service record for former employees. If CCISD has provided you an original service record in the past, please contact the school district where you were most recently employed to obtain the original. Please add a note when requesting service records for an active employee enrolling in a graduate program.

Please allow up to 30 days after your final day of service or date of the request for processing.

Please provide the following information. Your request will be sent via email to the CCISD Certification Specialist. Depending on your preference, your service record will be emailed or mailed to your new District within 30 days of the date of the request. Service records must be transferred directly from district-to-district to be considered official documents.

Employee Information

Full Name (At Time of Employment)required

First Name

Middle (optional)

Last Name

Other Names Used

Employee ID Number (If Known)

Last 4 Digits of Social Security Numberrequired

Must contain only numbers

Email Addressrequired

Phone Numberrequired

Employment Information

CCISD Position Held (Job Title or Assignment)

Approximate Dates Worked

Start Date

Must contain a date in M/D/YYYY format

End Date

Must contain a date in M/D/YYYY format

Additional Information

Please share any additional information that could be helpful to locate your records

Service Record Delivery Information

Please tell us where to send the requested service record. Our preference is to send records via email. Please note, the email address provided must be an official district email to be considered an official document. We can also mail printed records.

What is Your Preferred Delivery Method?

New District Point of Contactrequired

Name

New District Email Address

District Name

Mailing Address

City

State

Zip Code

Processing Time

Please allow up to 30 days from the date of the request or your final working day (whichever came last) for your service record to be processed. You will receive a confirmation email upon completing this form. Please check your spam/junk inbox if you do not receive the email confirmation.

Thank you!