Employee Record

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Employee Record
First Name
Middle Name
Last Name
Social Security Number
Home Telephone
Official Telephone
Date Of Birth
Age
Will Be 65 On
Dependents
Education
Years Attended
MM
DD
YY
MM
DD
YY
Elementary
High School
Mailing Address
City
State
Zip
Trade School
College
Residing At:
Distance Ed.
Other
In Case Of Emergency, Notify:
Phone Numbers Of Emergency Contacts:
Misc. Information
Sex: Male
Female
Marital Status : Married
Single
Divorced
Spouse’s Name
Date Of Birth
Medical Conditions
General Health
Height
Weight
Hair Color
Eye Color
Union Affiliation
Job Classification And Grade
Insurance
Pension/401(k)
Other
Eligibility Date
Worked
Worked
Starting
Ending
Reason For
Previous Employer
Position
References
From
Till
Wage
Wage
Leaving
Comments:
Hired By:
Date:
Project Or Location:
Termination Information
Termination Date
From Project / Location
Terminated By
Recommended For Re-
Employment?
|
Yes
No
Notes / Comments:

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