Attention: Personnel Officer

To whom it may concern:
    
     I,____________________ hereby request an opportunity to review my personnel records and  
may request copies of such provided to me pursuant to the Bullard-Plawecki Employee Right to Know
Act  being public act 1978 No. 397 or MCL 423.501
et seg.
    
As used in the Act, I understand you will provide an opportunity for me to review and provide copies
of any and all records, documents, notes or memorandum that are being used or have been used, or
may be relative to my qualifications for employment promotion, transfer, compensation or disciplinary
action. This also includes those records in the possession of your agents, servants and/or
employees.

     I will gladly pay
if copies of records are requested for myself, upon receipt of such copies any fee
you incur limited to the actual incremental cost of duplication. Further, I would ask that within in ten
(10) days of the receipt of this letter, you would provide me with the opportunity to review and obtain
copies of my personnel file or a valid reason in writing as to why you cannot comply with this request.

                                                                                     Sincerely,





My address:___________________________________________________

My Phone #:_____________________
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