Employee Profile Screening Template

Please indicate whether you are a new employee or a current employee

1. New Employees: To update or add information to your HR/Payroll record, use this form. Fill out the form online, print it off, and sign it before sending it to the office of human resources.

2. Current Employees: To update your name and identity information, use this form. This form must be submitted in person together with a Legal Name Change Document and Social Security Card if your name is changing.

Employee Information

Full Name:                                                   Date of   Birth:

Address:

Street Address                                                                           Apartment/Unit #

City                                       State                                                       ZIP Code

Phone:             Email:                                         Gender: 

Marital Status: ☐ Single Married     ☐Divorced            ☐ Separated           ☐ Other:

Ethnicity/Race (check all that apply): Are You Hispanic/Latino?  ☐ Yes No

Education

Highest Education Level:                                     Highest Degree and Major:  

Date Acquired:                                                                           Institution 

Name:

Emergency Contacts

Name:                             Relationship:                                                               Address:    

Street Address                                                                             Apartment/Unit #

City

State

ZIP Code

Phone:                                                                                   Cell Phone:  

Name:  

Relationship:

Address:    

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone:   

Cell Phone: 

  •           Selective Service Certification

Select the one that best fits your situation under the Military Selective Service Act after carefully reviewing the alternatives listed below.

I hereby certify that:

  1. I am a male between the ages of 18 and 26, and as required by federal law, I have enrolled with the Selective Service System.
  1. I am not required to register since I am a female or a male above the age of 26.
  1. I am eligible for the registration, but I am under the legal drinking age. As soon as it’s time to register, I will.
  •   Disclaimer and Signature

I certify that, to the best of my knowledge, the information I have provided is accurate and full. I am aware that if my application results in employment, providing inaccurate or misleading information during the hiring process could result in my dismissal.

Signature:                                                                             Date:

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