Fillable Employment Data Sheet Pdf Revised NAME (Bowie State University)

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Employment Data Sheet Pdf Revised NAME (Bowie State University)

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File type: PDF

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BOWIE STATE UNIVERSITY
EMPLOYMENT DATA SHEET
NAME
LAST
FIRST
MIDDLE
CITY
STATE
COUNTY
ZIP
HOME TELEPHONE
( )
SOCIAL SECURITY NUMBER
DATE OF BIRTH
SEX
MARITAL STATUS
D – Divorced
M - Married
S – Single
T – Other
W – Widowed
X - Separated
ETHNIC CODE
*** See codes below
***
1 – White: Includes persons having origins in any of the people of Europe, North America or the Middle East
2 – Black: Includes persons having origins in any of the Black racial groups of Africa
3 – Asian or Pacific Islander: Includes persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Sub-Continent or the Pacific Islands.
This area includes, for example, China, Korea, the Philippine Islands and Samoa.
4 – American Indian or Alaskan Native: Includes persons having origins in any of the original peoples of North America, and who maintain cultural identification through
tribal affiliation.
5 – Hispanic: Includes persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture of origin.
ARE YOU A U.S. CITIZEN?
YES
NO
IF NO, PLEASE GIVE COUNTRY OF CITIZENSHIP
DO YOU HAVE PRIOR UNIVERSITY SYSTEM OF MARYLAND OR STATE AGENCY SERVICE?
Yes/No
Agency Name
Phone Number
Dates of Service
EDUCATION LEVEL
DEGREE Month/Year
DEGREE FIELD
DEGREE INSTITUTION
COUNTRY
Veteran
Vietnam Veteran
Other Protected Veteran
Armed Forces Service Medal Veteran
Yes/No
Yes/No
Yes/No
Yes/No
Recently Separated Veteran-One Year
Recently Separated Veteran-Three Years
Disabled
Yes/No
Yes/No
Yes/No
Disabled Status
(enter code)
01 Non Ambulatory Wheel Chair
02 Semi Ambulatory
03 Coordination
04 Sight
05 Hearing
06 Speech
07 Learning
08 Mental or Psychological
09 Other
10 Not Disabled
EMERGENCY CONTACT PERSON:
NAME
RELATIONSHIP
HOME ADDRESS
CITY
STATE
ZIP
HOME TELEPHONE #
BUSINESS TELEPHONE #
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Employment Data Sheet Pdf Revised NAME (Bowie State University)

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Completed 21 July 2020

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