The information below is for the Human Resources database and for the H-SC Campus Directory. Please fill out the form completely as indicated (where relevant) whether you want that information omitted from the H-SC Campus Directory or not.
HR Database and Campus Directory Information
First Name:
Middle Name/Initial:
Title:
Job Title:
Building & Room #:
Department:
Office Extension:
Campus PO Box:
Please complete this section in its entirety for HR Office use. Check the "yes" box only if you do not want this printed in the Campus Directory or published on the web.
Email Address:
Home Address:
Omit from publication?
Yes
Home Phone Number:
Omit from publication?
Yes
Spouse's Name:
HR Database Information (Confidential) except for those portions printed in the Campus Directory and published on the web site.
Date of Birth:
Social Security Number:
Date Hired:
Supervisor:
Name and date of birth for legal dependents still claimed on tax return:
