Employee Opt Out Form

First Name*
Last Name*
Employee ID Number*
For the prompts below please indicate whether you allow public access or not. Answering NO indicates you do NOT want this information shared. If you answer YES, the school district must share your information in any public information requests.
All personal information listed above*

NoYes
Home Address*

NoYes
Home Phone Number*

NoYes
Personal Cell Phone Number*

NoYes
Personal Email Address*

NoYes
Emergency Contact Information*

NoYes
Information that reveals whether you have family members*

NoYes
Employee Signature*

Clear
Should be Empty: