Knowledgebase-Personnel Information Form


Information Product

Title:Personnel Information Form
Summary:A sample form to be used for compliance with government record keeping and reporting requirements.
Original Author:Stokes, Richard
Co-Author:
Product Create Date:05/21/2012
Last Reviewed on::01/03/2017
Subject:Personnel--Forms
Type:Form
Original Document: PERSONNEL INFORMATION FORM.pdfPERSONNEL INFORMATION FORM.pdf

Reference Documents:

Text of Document:
PERSONNEL INFORMATION FORM


The information requested on this form will not affect you as an applicant for a position. This information is collected for compliance with government record keeping and reporting requirements. The information will be maintained in a confidential file separate from the employment application and will not be given to anyone who makes hiring decisions. We would appreciate your cooperation and assistance in our efforts to ensure equal employment opportunity.

DATE:
POSITION APPLIED FOR:

NAME: ____________________________________________________PHONE ( )______________________
LAST FIRST MI AREA CODE

ADDRESS:__________________________________________________________________________
NUMBER STREET CITY STATE ZIPCODE

DATE OF BIRTH: ______________________________________ SS#: _____________________________________


CHECK ONE:
SEX: [] MALE [] FEMALE
MARITAL STATUS: [] SINGLE [] MARRIED
[] DIVORCED [] SEPARATED

RACE/ETHNIC GROUP: [] WHITE [] BLACK [] HISPANIC
[] AMERICAN INDIAN [] ALASKAN NATIVE
[] ASIAN [] OTHER

DISABILITY: [] YES [] NO

VIETNAM ERA VETERAN: [] YES [] NO

DISABLED VETERAN: []YES []NO


NOTIFY IN CASE OF EMERGENCY

NAME________________________________________ RELATIONSHIP ___________________

ADDRESS _____________________________________ CITY ________________________ STATE _____________ ZIP ____________________

HOME PHONE_____________________________________________ BUSINESS PHONE _______________________________