General Employee Information Form - Carolina

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employeeInformationForm.pdf - revised 09/15/14
New Employee Information Form
The information you provide below will be used to update your file and the Faculty/Staff Directory unless you wish some
portion excluded. You should indicate where prompted any portion you do not wish to be included in the directory. If any
of the information below changes after you have returned this form, please notify the Office of Human Resources.
Please PRINT or TYPE the following information, and either submit the form electronically or send it to the Office of Human
Resources, 2070 Campus Box.
Name (last, first, and middle)
Preferred/Nickname (Directory Display Name)
Dr.Mr. Mrs. MissMs.
Street or P.O. Box
Mailing Address
City State Zip
Job Title
Home Phone # (include area code)
Name of spouse/domestic partner (if applicable)
County
Type of Employment
Full-time Part-time
Position Information
Department
Campus Box #
Office location (building and office number)
Campus Phone Extension (the number you want listed in the Faculty/Staff Directory)
Emergency Contact Information
Name (Primary)
Phone # (include area code)
yes
no
Racial/Ethnic Background
Colleges and universities are asked by many, including the federal government, accrediting associations, college guides,
newspapers, and our own university communities, to describe the racial/ethnic backgrounds of our students and employees. In
order to respond to these requests, we ask you to voluntarily answer the following two questions.
Do you consider yourself to be Hispanic/Latino?
In addition, select one or more of the following racial categories to describe yourself:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Yes No
Have you been employed by Elon previously?
If yes, when? From to
If you have worked at Elon under another name, list name
Office of Human Resources
Last four digits of your Social Security Number (Needed for data entry/payroll purposes. Will not be
included in the Faculty/Staff Directory.)
Cell Phone # (include area code)
Include in Directory?:
Yes No
Phone # (include area code)
Name (Primary)
Contact Information
Yes No
Include in Directory?:
Yes
No
Include in Directory?:
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