New Temporary Employee Personal Data Sheet
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1County of Albemarle
Human Resources Department
New TEMPORARY Employee Personal Data Sheet
Instructions: The following data is needed to establish a personnel record for you as a new employee in Albemarle
County. Please complete all information and, if changes occur, be sure to notify the Human Resources Department.
Forms for such changes are available through Human Resources. Forms are also available on-line at
Name:
(Last)
(First)
(Full Middle)
Social Security #:
Preferred First Name:
Address:
(Street)
(City)
(State)
(Zip)
Mailing Address:
(If different from shown above)
Home Phone #:
Work Phone #:
Home Email:
Work Email:
Birth Date:
Sex:
Male
Female
Race:
White
Black
Hispanic
Asian
American Indian
Two or more races
Pacific Islander
Name of School or Department:
Position:
Emergency Contact:
Name:
(Last)
(First)
(MI)
(Relationship)
Address:
(Street)
(City)
(State)
(Zip)
Phone #:
Other Phone #:
(Employee Signature)
(Date signed)
TEMPORARY EMPLOYEE PERSONAL DATA SHEET (04/2014) Recycle previous copies
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Parent category: Business