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Service Records Request

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Subject
First & Last Name (Required)
Former Name Used Whilte Employed (if applicable):
Email Address: (Required)
Phone Number: (Required)
Social Security Number: (Required)
Which of the following position(s) did you have while at NYOS Charter School? Pleae include all of the following that apply: Substitute Teacher, Hourly Staff, Salaried Staff, & Adminsitrative Staff: (Required)
I am requesting service records and I would like these records to be delivered via the following method: (Required)
If you would like service records to be emailed to an individual or organization, please provide an email address:
If you would like service records to be faxed to an individual or organization, please provide a fax number here:
If you would like service records to be mailed to an individual or organization, please provide a full mailing address here:
Email (Optional)
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