Alabama A&M University
Employee Profile
Banner ID—(A#) Email
Name:
First MI Last Suffix
Home Address:
Address City, State Zip
Telephone: ( ) ( ) ( )
Home Work Cell
Birthdate: Spouse:
Previously employed by AAMU: Yes No If yes, please indicate your employment classification(s):
Faculty Student Part-time
Staff Graduate Assistant
Marital Status Ethnicity/Race
Single Are you Hispanic or Latino? Yes____ No___
Married Select one or more:
Divorced American Indian or Alaska Native
Separated Asian
Widowed Black or African American
Native Hawaiian or other Pacific Islander
White
Languages Proficiency
________
________________________ ________
Teacher Retirement System
Are you current working for a state agency that requires
mandatory participation to the Teachers’ Retirement
System of Alabama?
Yes No
Professional Organizations/Societies
Professional Awards
Veteran Status
Vietnam Veteran only
Both Vietnam and other eligible veteran
Other protected veteran only
Special disabled
Citizenship/Country
USA Other
Non-U.S. Citizen must enter information below:
Visa Type:
Expiration date:
Country:
Admission /Alien Number:
Military Reserve Status
Not in Reserve Retired
Active Reserve Inactive Reserve
Inactive Reserve subject to call up
Vietnam Era Veteran
Separation Date:
Emergency Contacts
Primary
Name:
Address:
Relationship:
Telephone ( )
Secondary
Name:
Address:
Relationship:
Telephone ( )
Sex: Male
Female
Driver’s License Number:
Education
Highest degree awarded:
Degree date (MM/DD/YY)
Degree Institution
Institution location (City/State)
Major
Other degree awarded:
Degree date (MM/DD/YY)
Degree Institution
Institution location (City/State)
Major
Revised October 2012
Signature: Date:
