Personal Data Sheet - Colgate University - Office Of Human Resources
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1COLGATE UNIVERSITY
OFFICE OF HUMAN RESOURCES
CONFIDENTIAL
Banner ID: _________________
Dr.
Mr.
Mrs.
Ms.
Miss
Other__________
Department: ________________________________
Legal Name: ____________________________________
Social Security Number:_______________________
Preferred First Name: _____________________________
Date of Birth: _______________________________
Phone Number: _________________________________
Current Email Address: _______________________
(for correspondence prior to your arrival at Colgate)
Address: _______________________________________
Cell Phone Number:__________________________
_______________________________________________
(for the University Emergency Notification system)
_______________________________________________
ETHNICITY:
Hispanic/Latino
Non-Hispanic/Latino
RACE:
American Indian/Alaskan Native
Asian American/Asian
Black/African American
Native Hawaiian/Pacific Islander
White
GENDER:
Male
Female
GENDER PRONOUN:
He/Him/His
She/Her/Hers
Ze/Hir/Hirs
They/Them/Theirs
Name Only
MARITAL STATUS:
Married
Single
Partnered
Divorced
Separated
Widowed
V
VETERAN STATUS:
Not a Veteran
Protected Veteran
Active Wartime or Campaign Badge Veteran
Not a Protected Veteran
CITIZENSHIP:
US Citizen
Dual Citizen
Non-Immigrant Alien
Permanent Resident Alien
Complete the following section only if your appointment includes benefits (eg health, life, etc):
List Spouse/Partner* & Dependents
Relationship
Social Security Number
Date of Birth
Gender
*Is your spouse/domestic partner an employee at Colgate University?
Yes
No
(To qualify for domestic partner benefits, you may be asked to complete a Domestic Partner Application)
I understand that I must notify Human Resources of any changes to the above information. Failure to report changes
may delay or forfeit my ability to be eligible for certain benefits.
Employee Signature_____________________________________________
Date_________________________
This information is voluntarily provided and will be kept confidential and used only in accordance with applicable regulations.
(Revised April 2016)
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