Employee Data Form
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1EMPLOYEE DATA FORM
(ALL DATA MUST BE COMPLETED FOR PAYROLL PROCESSING)
*Last Name:_________________ First Name:__________________ MI:____ Known By:____________________
Address:______________________________________________________City:__________________________
State:________ Zip:___________
Phone: ___________________
Male
Female
Title:
Mr.
Mrs.
Miss
Ms.
Dr.
Rev.
Sr.
Suffix:
DDS
PhD
MD
SJ
Jr.
Social Security Number: ________________
Date of Birth: ___________
Status:
Single
Married
Department:___________________________ Hire Date: _______________
Registered Disabled:
Yes
No
Religion:
Baptist
Cleric Religion:
Not Applicable
Buddhist
Jesuit
Catholic
Non-Jesuit Catholic Clergy
Veteran Status:
Not a Veteran
Eastern Orthodox
Other Non-Catholic Clergy
Disabled Veteran
Episcopal/Anglican
Women Religious
Disabled Vietnam Veteran
Evangelical
Vietnam Veteran
Hindu
* If you have previously
Other Eligible Veteran
Jewish
been issued an MUID and
Other Eligible Disabled Veteran
Lutheran
your name has changed,
Methodist
you must submit a Name
Separation Date:_____________________
Muslim
Change Request Form,
Other Christian
available from the MU
Other Non-Christian
Central web site. A
Presbyterian
Marquette University
UCC
Identification Number
Not Applicable
(MUID) is issued to
Ethnic Origin:
Are you Hispanic or Latino?
students, student
Yes, I am Hispanic or Latino
applicants, parents, and
No, I am not Hispanic or Latino
employees.
No matter what you selected above, please continue to answer the following question.
What is your Race? (Select one or more)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Highest Degree Obtained:
High School
GED/HED
Associate
Bachelor
Master
PhD
DDS
MD
JD
Date Received:______________________ Institution Name:__________________________________
Emergency Contact Name:_____________________________ Contact Address:___________________________________
Contact Phone Number: _________________
Relation to Employee:___________________
Send completed form to Human Resources IMMEDIATELY (Before Date of Hire) by email, fax or regular mail
Marquette University, Department of Human Resources, Straz Tower Rm. 185
P.O. Box 1881
Milwaukee, WI 53201-1881
(414)288-7305 Fax: (414)288-7425
Email:
humanresources@marquette.edu
HR 11/11
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