Emergency Notification Information - Georgian Court University
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1OFFICE OF HUMAN RESOURCES
Emergency Notification Contact Information Form
Employee Information
Last 4 digit of
SS# for HR
Employee Name
reference only
GCU Ext #
Department
Home Phone #
Cell Phone #
In addition to phone calls, do you wish to receive GCU emergency notification through text
Yes
No
message?
Alternate Phone #
Alternate Phone #
(Please note the University Emergency Notification System sends messages to direct phone numbers only, not to phone numbers with extension
line)
E-Mail 1 - GCU
E-Mail 2
Special Instructions
(Medic Alert
Information, etc)
Emergency Contact Information
Name of Contact Person
Relationship to Employee
Address
Street
City
State
Zip
Home
Cell
Work
Phone #
Phone #
Phone#
Employee Signature
Date
Rev9/09
HR use only
ID #
_____________________
____________________
_____________________
HRIS
Connect-Ed
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Parent category: Business