Employee Information Form
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1Employee Information Form
Revised 2/2015
Instructions:
You can update this information online using the Employee Information System at https://utdirect.utexas.edu/pnbiog/index.WBX. If
you do not have access to the online system, print a copy of this form, complete it, and return it to your supervisor or the HR Contact in
your department. DO NOT RETURN THIS FORM TO HUMAN RESOURCES.
First name
Middle name
Last name
UT EID
E-mail
Home phone
Street address
City
State
Zip code
Office Location
Information Release -- Do Not Release My...
(Mark all that apply)
Primary location
Social Security Number
Building
Room
Office phone
Family Information
Secondary location
Home Address(es)
Building
Room
Office phone
Home Phone Number(s)
Emergency Contact
Pager
Fax
Campus mail code
Ethnicity
Emergency Contacts
Yes
No
Are you Hispanic?
Primary contact
Race (check all that apply)
American Indian/Alaskan native
Name
Relationship
Asian
Black
Phone 1
Phone 2
Native Hawaiian/Pacific Islander
White
Secondary contact
Male
Female
Gender
Education
Name
Relationship
Indicate highest level of education achieved.
Less than high school
Phone 1
Phone 2
High school diploma/GED
Teaching Experience
Associate’s degree
Please indicate the years of HIGHER education teaching experience you have
(excluding TA experience)
Certificate of completion
Total years of teaching experience
Bachelor’s degree
Total years of teaching experience at UT Austin
Master’s degree
Former Foster Children
Professional degree
Are you less than the age of 25 and an orphan under permanent managing
(LLB, JD, ThD, PharmD)
conservatorship of the Department of Family and Protective Services (DFPS)?
Doctorate (PhD,EdD)
Yes
No
Medical degree (MD, DVM, DDS)
Highest degree abbreviation
Year degree completed
Signature of employee
EID
Date form signed
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Parent category: Business