HR Rev. 01/2020
NEW EMPLOYEE PERSONAL DATA FORM
TEMPORARY (Hourly)
INTERN (Stipend)
CONTRACTUAL NO BENEFITS (Contract)
ADJUNCT FACULTY - Credit or Continuing Education (Stipend)
Instructions: The following data is needed to establish a personnel record for you as a new employee at AACC.
Please complete all information and, if changes occur, be sure to notify the Human Resources Department. Forms for such changes
are available through Human Resources or can be found on the Intranet, Human Resources, Forms.
PLEASE PRINT
Social Security Number: ______ - ______ - _______ Employment Start Date: ______________________
Name
Prefix Last Name
First Name
MI
Suffix
Street Address
Zip
County Township (PA only) City State
Date of Birth (MM/DD/YYYY): ______________________
Gender: Male Female
Home Telephone Number Cell Telephone Number Email Address
THE FOLLOWING INFORMATION IS REQUIRED FOR INSTITUTIONAL STATISTICAL DATA REPORTING PURPOSES:
Hispanic or Latino
Not Hispanic or Latino
Race (check one or more)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
EMERGENCY CONTACT INFORMATION:
Primary Contact:
Relationship
Day Phone Evening Phone
The information contained on this form is true and accurate to the best of my knowledge:
Date
ATTENTION: HIRING MANAGER, INSTRUCTIONAL SPECIALIST, DEPARTMENT CHAIR OR DESIGNEE
To ensure timely processing of payroll, please see that the following documents listed below are forwarded as a packet
with this Personal Data Form for all new hires. All items are required and must be received in Human Resources before
we can legally enter a new hire into Colleague.
All Employees:
I-9 Form (Employment Eligibility Verification Form)
Temporary Employee Hiring Request (hourly only)
State Tax Form
Federal Tax Form
Also required for Adjunct Faculty:
Undergraduate & Graduate Official Transcripts (submit directly to Office for Learning with application, resume
and cover letter to attention of Associate Vice President for Learning, LUDLUM 204A)
Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or Maryland Relay 711, 72 hours
in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and
complaints concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or
Maryland Relay 711.
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