TO BE COMPLETED BY NEW HIRE EMPLOYEES
JACKSONVILLE UNIVERSITY JU I.D. #:____________________
ONLY (FOR ADMIN USE ONLY)
□ New Hire Employee Information Sheet
□ Re-Hire Employee Information Sheet
Last Name: ________________________________ First Name:_______________________ MI:_________
Personal
Date of Birth: ________________ Gender: _____ SS#:____________________________________________
Street Address: ____________________________________________________________________________
City/State/County/Zip:_______________________________________________________________________
Home Phone: ___________________________ Cell Phone: _______________________________________
Ethnicity: □ Black, non-Hispanic □ White, non-Hispanic □ American Indian-Alas □ Asian/Pacific Isl □ Hispanic □ Other
Emergency
Emergency Contact Name: _______________________________ Phone #:____________________________
Address:__________________________________________ City/State/Zip:____________________________
(Administrative Offices Only below this Line)
Hiring Authority
Start Date : ________________ End Date (if applicable): _______________
Position:___________________________________ FT or PT:______________ Salary:__________________
Department:____________________ Fund Code:______________ Acct. #:_____________________________
New Employee’s Office Phone Number:_________________________ Fax: ___________________________
New Employee’s Building / Room Number: _____________________________________________________
Replacing:_________________________________________________________________________________
Hiring Authority Name Dept. Ext
ATTACH I-9 and W-4 to this form and return original to Academic Affairs
Academic Affairs / Faculty
Highest Degree: Type____________________ Date____________ Where_____________________________
Terminal Degree? Yes / No Rank: □Visiting □ ADJ □ Instructor □ ASST □ ASSOC □ PROF
CUPA Code:_____________ □ Non-Tenure Track □ Tenure Track □ Tenured
