EMPLOYEE SIGNATURE ABOVE:
only, and will make every effort and attempt to update the CCCO should any of the above information change during the course of my employment
with the office. Finally, I understand that the above information is needed to ensure proper employment processing with the CCCO.
ARE YOU A RETURNING ELECTION WORKER?: (YES OR NO)
ARE YOU A RETIRED COOK COUNTY EMPLOYEE?: (YES OR NO)
ETHNICITY [OPTIONAL]: (PLEASE PRINT BELOW)
MARITAL STATUS: (PLEASE PRINT BELOW)
KAREN A. YARBROUGH I COOK COUNTY CLERK'S OFFICE
69 West Washington Street, Suite 500, Chicago, Il 60602
Telephone: 312.603.0916 I Fax: 312.603.4899 I Web Address: cookcountyclerk.com
EMPLOYEE PERSONNEL FORM (PLEASE PRINT)
EMPLOYEE NAME: (PLEASE PRINT BELOW)
EMPLOYEE ID NUMBER: (PLEASE PRINT BELOW)
START DATE: (PLEASE PRINT BELOW)
DATE OF BIRTH: (PLEASE PRINT BELOW)
TAX ID/SSN: (PLEASE PRINT BELOW)
EMPLOYEE STATUS & CONTACT INFORMATION (SECTION I)
EMPLOYEE MAILING ADDRESS: (PLEASE PRINT BELOW)
EMPLOYEE PHONE/BEST CONTACT NUMBER: (PLEASE PRINT BELOW)
EMPLOYEE EMAIL ADDRESS: (PLEASE PRINT BELOW)
EMERGENCY CONTACT INFORMATION (SECTION II)
CONTACT NAME IN THE EVENT OF AN EMERGENCY: (PLEASE PRINT BELOW)
CONTACT PHONE NUMBER: (PLEASE PRINT BELOW)
CONTACT PERSON RELATIONSHIP: (PLEASE PRINT BELOW)
CONTACT EMAIL ADDRESS: (PLEASE PRINT BELOW)
RETURNING EMPLOYEE WORK HISTORY QUESTIONNAIRE (SECTION III)
ARE YOU A CURRENT COOK COUNTY EMPLOYEE?: (YES OR NO)
COOK COUNTY EMPLOYEE ID NUMBER (IF CURRENT EMPLOYEE):
EMPLOYEE CONSENT STATEMENT (SECTION IV)
By signing this Employee Personnel Form, I hereby acknowledge and confirm that the above information is the accurate information concerning my
personal, prior professional and existing professional employment status. Furthermore, by signing this form I am also granting the Cook County Clerk's
Office ("CCCO") permission to utilize any and all contact information (for myself, or my emergency contact) for necessary or legally permitted purposes
