This form is required to be completed by each employee.
Name Banner ID # 900
Home Address
Street
City, State Zip
Street
City, State Zip
Department Work Phone #
Work Email Address
Supervisor
Job Location
In Socorro Building Room #
In New Mexico Cit
y
Out of State Cit
y
State % of time at location
City State % of time at location
Signature Date
Comments:
Admin Use Only:
Human Resources Budget
Position # Payroll
Human Resources / Payroll Office
575-835-5206 / 575-835-5510
Please return to Human Resources Office.
Please Print
Phone Directory #
W-2 Mailing Address (if different)
nmt.edu
click to sign
signature
click to edit