New Employee Information Form printable pdf download

NEW EMPLOYEE INFORMATION FORM

Social Security #:__________________________________

Employee I.D._________________ (leave blank)

Print Legal Name: _____________________________________________________________________________

Last

First

Previous Names(s): ___________________________________________________________________________

Maiden Name

Other Married Name(s)

AKA (also known as)

Date of Birth: ____________________________

Sex: Male _____ Female_____

Home Address: _______________________________________________________________________________

Street

City

State/Zip

Home Phone: _____________________________

Cell Phone: ____________________________

ETHNICITY/ RACE

The United States Department of Education has directed how various combinations of ethnicity/race are to be reported.

Please answer BOTH questions. Question 1 is about ethnicity (origin), not race. No matter what you select in

question 1, be sure to answer question 2 describing your race.

Note: Failure to answer BOTH questions will result in use of prior racial/ethnic data or an observed

identifying for you.

Ethnicity: Do you consider yourself to be of Hispanic/Latino origin? (Choose only one).

_____ No. Not Hispanic/Latino (PLEASE BE SURE TO ANSWER QUESTION 2)

_____ Yes Hispanic/Latino. A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central

American, or other Spanish culture of origin, regardless of race. (PLEASE BE SURE TO ANSWER

QUESTION 2)

2. Race: Which of the following groups describe your race? (Choose one or more)

_____ American Indian or Alaska Native. A person having origins in any of the original peoples of

North and South America (including Central America) and who maintains tribal affiliation or

community attachment.

_____ Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or

the Indian subcontinent including, for example, Cambodia, China India, Japan, Korea, Malaysia,

Pakistan, the Philippine Island, Thailand and Vietnam.

_____ Black or African American. A person having origins in any of the black racial groups of Africa.

_____ White. A person having origins in any of the original peoples of Europe, the Middle East or North

Africa.

EMERGENCY CONTACT

Please provide an emergency contact who can be reached during YOUR working hours.

Name: ______________________________________________ Relationship_____________________________

Home Phone: ____________________ Work Phone: ___________________ Cell Phone: ___________________

New Employee Information Form