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:
- 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.
- I am not required to register since I am a female or a male above the age of 26.
- 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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