Rev 3/19/13
Employee Database
Please Print
Dr. Mr. Ms. Name
Last First Middle Int. A #
Employee's Birthday Spouse's Name
(if applicable)
Home Address
Home Telephone Number
Work Phone Number Office Location
Campus E-Mail Address
Education (example: B.S. 1997, Lake Superior State University; M.B.A. 1999, Lake
Superior State University)
I would like to be listed in the LSSU web site personnel directory.
Yes No
In addition, photographs are included on the LSSU web site personnel directory. Do you want your
photograph on the web site personnel directory?
Yes No
For Human Resources Office Use.
Hire Date
Employee Group: A/P ESP FAC
Web Updated __________
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