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Alfred University Personnel Data Form
Employee Personal Information
Prefix: Dr. Mr. Mrs. Ms.
Name:
Last First MI
Address:
Street Apt/Unit
Mailing (if different)
City State Zip Code
Home Phone:
( )
Alternate Phone:
( )
Social Security: Preferred First Name:
Birth Date: Marital Status:
Spouse’s Name: Maiden Name:
Yes
Are you a Veteran?
No
If yes: Veteran File # Date of Discharge:
What type Veteran are you?
Vietnam Era Newly Separated Other Protected
Armed Forces Service Medal Indicator? Special Disabled
Affirmative Action EEO data – Ethnic Background
Hispanic of any Race For Non-Hispanic/Latino; please further define race below:
Alfred University is an Equal
Opportunity/AA employer.
Information provided is
voluntary and confidential and
used for legal reporting
purposes only.
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
I
choose not to identify
Asian Black or Af
rican American
Two or More Races
Job Information
Title: Banner ID:
Supervisor: Department:
Building: Room Number:
Office Phone:
Office Fax:
Email
E-mail is the official means of communication at Alfred University. To create your account, ITS will use your last name or a
combination of your last name and first initial depending on the user names already in our system. You will be notified by ITS
when your user name has been activated with a temporary password and we strongly suggest that you change your temporary
password after the first log in. Your signature below indicates that you have read and agree to the Alfred University computing
policies at: https://my.alfred.edu/information-technology-services/policies/policy.cfm.
Signature:
Date:
Emergency Contact Information
Name:
Address:
Last
Street
First MI
Apt/Unit#
Phone:
( )
State
Alternate Phone:
( )
Zip
Relationship:
click to sign
signature
click to edit
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