HomeMy WebLinkAbout1. Employee information form 2020 fillable
Employee Information
☐ New Employee: Please complete all information
☐ Info Change/Update: Only complete name and items being changed Date Submitted:
Personal Information
Full Name: Last First M.I.
Address:
Street Address Apartment/Unit #
City State ZIP Code
Cell Phone: Home Phone:
Email:
SSN or Gov’t ID: Gender: ☐ Male ☐Female ☐ Non-Binary
Birth Date: Marital Status: ☐ Single ☐ Married ☐Other:____________________
Spouse/RDP Name:
Employer: Spouse Phone: Optional EEO Race: ☐White ☐Black ☐Hispanic
☐Asian/PI ☐American Native ☐Other
Ethnicity: ☐Hispanic/Latinx
☐Not Hispanic/Latinx
Emergency Contact
Full Name:
Last First M.I.
Address: Street Address Apartment/Unit #
City State ZIP Code
Cell Phone: Alternate Phone:
Relationship: