Fillable Employee Data Collection Form printable pdf download

Employee Data Collection Form

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Complete Employee Data Collection Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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Employee Data Collection Form

1. Employee Information

SS#:

Last Name:

First Name:

Middle Name:

Suffix Name (check one):

Racial Identity:

III

Jr.

Sr. None

Not Reported

Amer Indian/Alaska Nat

Birth Date:_____________

Black/African American

Asian/Pacific Islander

Hispanic

White

Gender:

Citizenship/Visa Status:

Citizenship Country

____________________

__________________

Female

Male

Visa or Perm. Res.

Retired form State:

Check Distribution Code:

#:___________________

_______________

___________________

Highest Education Level

(check one):

Less than 7

grade

, 8

, 9

grade completed

Military Status (check one):

, 11

grade completed

High School Grad or GED

Non-Veteran

Some Bus. Sch. College (HS Grad)

Veteran

Associate Degree Earned

Vietnam Veteran

Bachelor’s Degree

Active Reserve

Some Graduate Study

Inactive Reserve

Advanced Grad Specialist (AGS)

Retired

Master’s Degree earned

Special Disability

Doctoral Degree earned

First Professional Degree earned

2. Employee Address Information

Business/Office Address:

Business Phone Number:

Permanent Address:

City:

County:

State:

Zip:

3. Employee Email Address

Primary Email Address:

Home Phone:

4. Employee Education Information

State Degree Earned:

Institution:

Degree:

Degree Date:

5. Emergency Contact Information

Contact Name:

Relationship:

Address:

Home Phone Number:

Cell Phone/Pager:

Work Phone Number:

Email Address:

Employee Data Collection Form

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