Form Sfn 13091 - State Hrms Personal Data Form (Page 2 of 3) in pdf

Form Sfn 13091 - State Hrms Personal Data Form Page 2

If the employee has more than one address or email address or more than 2 telephone

numbers that they would like listed on their personal data, they may fill out the

information on a separate sheet and attach it to this form.

Regional:

Ethnic Group: Check the applicable group.

Military Status: This is optional line of history. The employee may check the

appropriate military status.

Pay Method Options:

Check the option of check or direct deposit. If direct deposit is checked, SFN 50428 will

also need to be completed.

Previous Employment: If the employee has previously been employed by the State of

ND or the ND University System they should check yes and may already have an

employee id number in Peoplesoft.

Emergency Contact Information:

Emergency Contact Name: Enter the employee’s primary emergency contact person.

Primary Contact: Each employee must have one primary contact.

Relationship to Employee: Examples are spouse, parent, child, brother, etc.

If the address and phone number of the contact person are the same as the employee’s,

check yes on the appropriate lines and skip the contact person’s address lines.

Address Information: If the information is not the same as the employees then enter the

Street and/or P.O. Box, City, County, Zip Code, and State information for the primary

contact person.

Contact Phone: If the contact’s phone number is not the same as the employee’s listed

phone number, then enter it on this line.

If the employee has additional contact persons, please fill out the appropriate information

on another sheet and attach it to this form.

Employee’s Signature:

This form should be signed and dated by the employee.

Form Sfn 13091 - State Hrms Personal Data Form Page 2