Employee Information Form
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1E
I
MPLOYEE
NFORMATION
This information is used for payroll, human resources and reporting purposes.
First Name, Middle Initial, and Last Name: ____________________________________________________
_____________________________
Preferred First Name:
____________________________________________________________
Street Address:
____________________________________________________
City, State, and Zip Code:
: ____________________
Home Phone
Cell Phone: ___________________________
___________
Date of Birth:
Driver’s License Number: _____________________ State: _______
Expiration Date: __________
Job Title:
__________________________________________________________________________________
______________________________________________________________
Department:
Campus Extension: _______________ Campus Address:
___________________________
EMERGENCY CONTACT INFORMATION:
In case of emergency, please contact:
Name:
___________________________________________________
Street Address: _____________________________________________________________________________
City, State, and Zip Code: ___________________________________________________________________
Relationship: _________________________________ Phone: ___________________
POST-SECONDARY EDUCATION:
Degree (
): ________________________________
I.E. Master of Science or Bachelors of Fine Arts
Institution:
______________________________________________________________
Majors: _________________________________________________________________
Minors: _________________________________________________________________
Date of Completion: __________________
RECRUITMENT SURVEY:
How did you learn about your position?
□ FSU website
□ FSU employee
□ Newspaper
_______________________________________________
□ Other print publication ________________________________
_____
□ Other website or electronic medium _____________________________
□
Other ________________________________
___________
For accurate workforce data and compliance with regulatory requirements, the University
requests the following voluntary disclosures of demographic information:
CITIZENSHIP:
U.S. Citizen
Non-U.S. Citizen
MARITAL STATUS:
Single
Married
SEX:
Male
Female
RACE & ETHNICITY:
Are you Hispanic or Latino?
Yes
No
What is your race? (Choose one or more):
Native Hawaiian or Other Pacific Islander
Black or African American
White
American Indian or Alaskan Native
Asian
Signature: _______________________________
Date: _______________
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