New Employee Profile
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1
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3NEW EMPLOYEE PROFILE
CLEAR FORM
DEMOGRAPHIC INFORMATION
Legal Name
Preferred First Name
Last
First
Middle
SSN
Birth Date
Home Phone
U.S. Citizen
Yes
No
Street
Home Address
City
State
Zip Code
County
Race and Ethnicity Background
Are you Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture, regardless of race)?
Yes
No
Select one or more:
American Indian or Alaska Native – A person having origins in any of the original peoples of North, Central or South American
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
Black or African American – A person having origins in any of the black racial groups of Africa
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands
White – A person having origins in any of the original peoples of Europe, the Middle East or North Africa
Unknown
If you selected more than one race and ethnic background above, please state which you wish to identify as primary: ___________________
Gender
Marital Status
U.S. Veteran Status
(Optional)
Male
Married
Single
Yes
Female
No
Disability Status
(Optional)
Do you have a disability, as defined below, which substantially limits you from performing one of life's major activities?
A person with a disability is one who has a physical or mental impairment, which substantially
Yes
No
limits one or more major life activities*.
*Major life activities are the basic activities that the average person can perform with little or no difficulty, such as caring for one's self,
performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, sitting, standing, lifting, reaching, and working.
Teachers Retirement Association
Are you a TRA Annuitant?
Yes
No
Early Separation Incentive
Have you ever received an early separation incentive from State of Minnesota employment whether under Minnesota State Colleges and
Universities policy, employment bargaining agreement provision, or State of Minnesota policy?
Yes
No
ON-CAMPUS INFORMATION
(If you are unsure of this information, contact your department secretary.)
If your position is split between 2 departments, list the 2nd department information on the line to the right.
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2.
Department:
This is the primary department to which you are assigned.
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2.
Mail Code:
Building & room where mail will be sent. May be different than actual office location.
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2.
Actual Office Location:
The building and room number of your actual office.
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2.
Office Phone:
This number will appear in campus publications. If not listing your personal office phone notify the dept. secretary.
Minnesota State Mankato is an Affirmative Action/Equal Opportunity University.
Rev Oct 10
This document is available in alternative format to individuals with disabilities by calling Human Resources at (507)389-2015 (V) or (800)627-3529 (MRS/TTY).
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Parent category: Business