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Personnel Information Form

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Reviewed Date: January 03, 2017

Original Author: 
Stokes, Richard
Date Created: 
May 21, 2012


Subjects:
Personnel--Forms

Personnel Information Form

Summary: 
A sample form to be used for compliance with government record keeping and reporting requirements.

Knowledgebase-Personnel Information Form


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 _______________________________


Attachment(s):

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MTAS letters and publications were written based upon the law at the time and/or a specific sets of facts. The laws referenced in the letters and publications may have changed and/or the technical advice provided may not be applicable to your city or circumstances. Always consult with your city attorney or an MTAS consultant before taking any action based on information contained in this database.