Personnel File Request

Data from your Personnel file can be printed directly out of Workday through Self Service. We ask that partners use the Self Service options to obtain this information or you can open a case in Workday help or by emailing AskHR@mhemail.org.

Employment Verifications (Verifications of Employment) are now managed through the Work Number.
Employer verification code: 4618417
Verifiers should visit theworknumber.com, call (800) 367-5690, or email member@Equifax.com to fulfill their verification requests.

Name Name * First Last
Is the name above the same as recorded in Mercyhealth? *

Is the name above the same as recorded in Mercyhealth? Yes No
Name While Employed at Mercyhealth Name While Employed at Mercyhealth * First Last
Employment Status *

Employment Status Current Termed
Employee ID Number (Optional)
Employee ID Number *
Last Day of Employment (or closest approximation) Last Day of Employment (or closest approximation) * / MM / DD YYYY
Current Phone Number Current Phone Number * - ### - ### ####
Select which file(s) you are requesting *

Select which file(s) you are requesting Immunizations & Vaccinations Respirator Fit Test Full Employee Health File Pay Statement W2 Kronos/Payroll Timecard Evaluation(s) Full Personnel File Other

Employment Verifications are now managed through the Work Number.
Employer verification code: 4618417
Verifiers should visit theworknumber.com, call (800) 367-5690, or email member@Equifax.com to fulfill their verification requests.
Immunizations & Vaccinations

Immunizations & Vaccinations Measles Mumps Rubella Varicella (Chicken Pox) Hepatitis B Tuberculosis (TB) Tdap Influenza COVID-19
Immunizations & Vaccinations

Immunizations & Vaccinations Most Recent All recorded
Respirator Fit Test

Respirator Fit Test Most Recent All recorded
For Immunizations, Vaccinations, Fit Testing or Full Employee Health file: Please specify date range(s) *
For Pay Statement, W2 or Kronos/Payroll Timecard: Please specify date range(s) *
For Evaluation(s) or Full Personnel File: Please specify year(s) or date range(s) *
Other: Please specify records being requested along with date range(s) if applicable *
Select how you would like the document(s) delivered *

Select how you would like the document(s) delivered Pick up Mail Fax Email
Pick up at: *

Pick up at: HR Front Desk - MercyCare Building, 580 N. Washington St., Janesville, WI 53548 HR Front Desk - Javon Bea Hospital-Rockton, 2400 N. Rockton Ave., Rockford, IL 61103
Name of Individual or Company Receiving Mail *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Name of Individual or Company Receiving Fax *
Fax Number Fax Number * - ### - ### ####
Email Address *
You will be provided the documentation within seven days of this request by mail or pickup

Certain records may be exempt from review under provisions of the Illinois and Personnel Record Act. This could include, but is not limited to, letters of reference, criminal background check information, test documents (except that the employee may see a cumulative total test score), etc.

*Mercyhealth does not include policies, handbooks or procedures in a personnel file, and they are not documents available upon request by a third party.
Draw or type your signature into the box below. *

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Full Name

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Date Completed:
HR Administrative Approval
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Comments

Personnel File Request

Personnel File Request

You will be provided the documentation within seven days of this request by mail or pickup