Fillable Human Resources Department Emergency Contact Information Person to (Western Connecticut State University)

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Human Resources Department Emergency Contact Information Person to (Western Connecticut State University)

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Human Resources Department – Emergency Contact Information
We require each employee provide to us the name, address and telephone number of the
individual to be contacted in the event of an emergency.
Person to Be Contacted In Case of Emergency
Name:_____________________________________________ Relationship:_______________
Address: ______________________________________________________________________
______________________________________________________________________________
Telephone Number: _____________________________
Printed Name: ______________________________________ Date:______________________
Employee Signature:_____________________________________________________________
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Human Resources Department Emergency Contact Information Person to (Western Connecticut State University)

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Completed 24 July 2020

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