Revised 02/22/2012
Department of Human Resources
National Park Community College
EMPLOYEE HIRE INFORMATION
NPCC ID: ______________________________
Last Name: ____________________________M/I _______ First Name: _______________________
Home Phone: __________________________ Cell Phone: _________________________________
E-mail:____________________________________________________________________________
Home Address: _____________________________________________________________________
City: _____________________________________________ State: __________ ZIP: _________
Birth Date: ________________ Sex: F M Social Security# ___________________________
Hire Date: _____________Home Dept: _________________________________________________
Supervisor: _______________________________ Position: _________________________________
Race/Ethnicity: Choose one of the following:
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
White
Native Hawaiian or Other Pacific Islander
Nonresident alien
Ethnicity unknown
Current NPCC Student: Yes No
If yes, total hours currently enrolled __________
Highest Degree Level:
High School or Equivalent
Technical Certification
Two-year Associates Degree
Bachelor’s Degree
Master’s Degree
Doctorate
Concurrent Employment:
Are you presently employed with another state facility? No Yes
If yes, where? ______________________________________________________________________
Do you have Prior Service with a state agency? No Yes
Are you a current member of Arkansas Teacher’s Retirement Service (ATRS)? No Yes
Are you a current member of Arkansas Public Employee Retirement System (APERS)? No Yes
How did you learn of this position?
NPCC website
NPCC Employee
Newspaper
Other ____________________
Are you a veteran? Yes No
If yes, type of discharge:
Honorable Dishonorable
I am currently active duty
Military.