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Email
*
Your email
Employee Number (Assigned by Human Resources)
Your answer
Social Security Number -no dashes
*
Your answer
Last Name
*
Your answer
First Name
*
Your answer
Middle Initial
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Telephone Number -Include dashes
*
Your answer
Date of Birth - yyyymmdd - no slashes
*
Your answer
Date of Hire
MM
/
DD
/
YYYY
Gender
*
Female
Male
Marital Status
*
Single
Married
Divorced
Ethnicity
*
Yes, Hispanic or Latino
No, not Hispanic or Latino
Ethnic Code
*
A - Asian
B - Black
I - American Indian
N - None Specified
W - Caucasian
Other:
Emergency Contact Information - Name
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Emergency Contact Information - Relationship
Child
Other
Spouse
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Emergency Contact Information - Phone Number-include dashes
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EEO Information - Employment Status
F - Full time
P - Part time
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EEO Information - Please check box
20 - School Functions - EEO 5 Report
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