Los Alamos National Laboratory Employee Profile
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2Los Alamos National Laboratory Employee Profile
To assure a smooth transition into the Laboratory it is critical that you provide us with accurate
and complete information in each category. Please fill in all blanks. If the item does not apply
to you, enter N/A. Instructions and guidance are on page 2 of the form.
□
□
Z-Number:
_Hire Date:__/___/_
Date of Birth:
/
/__ Phone #:
Cell
Home __ _-______
Name: (Last, First, Middle) ________________________
_______________________________
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□
Prior LANL Employment:
Y
N
Date(s): _
_______________________
Organization: _
______
Address: Mailing Address
Your Mailing Address will be considered your primary address. All important Laboratory correspondence will be sent to
this address, including your paper W2. This address may also affect your state tax withholding. If you have questions,
contact the Tax Department at 505-665-0463 or tax@lanl.gov.
Street Address/PO Box:
City:__
_____
___
State:
Zip:
_
Address: Permanent Address (If different from above)**
Your Permanent Address will be your Physical Address (street, road etc.) or a home address that will remain constant.
(parents address, spouse address, etc.)
Street Address/PO Box:
City:__
_____
___
State:
Zip:
_ International:__ _________
___________
County or Area of Residence: ____ _________
____ School District:_ _
_
The county in which you reside,
or if you live in Los Alamos County, the geographical area within Los Alamos County in
which you reside.
The school district in which you
reside, regardless of where your children may attend school.
□
□
Ethnicity: __________ ______
Citizenship: ___
_______
Gender:
M
F
□
□
Marital Status:
M
S
Spouse’s Name: (Last, First) ____________
_
__________
□
□
Are you a Veteran
Y
N
Emergency Contact Information: Complete - Last Name, First Name, Middle Initial and or
Nicknames.
(Provide a Z# and/or Group if contact is employed or retired with the Laboratory. If
Z# and/or Group are unknown place a check mark next to the contact name.)
□
□
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Name: (Last, First MI) _____________
Phone #:
Cell
Wk
Hm ( _ __)___ -_______
Relationship: _____
___________________
Z#________________ Group____________________
□
□
□
Name: (Last, First MI) _____________
Phone #:
Cell
Wk
Hm ( _ __)___ -_______
Relationship: _____
____________
Z#________________ Group_____________________
Entered ______
Page 1
G:\New Hire Process\Forms/Employee Profile/June 2016
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