Personal Data Sheet
(A new form should be submitted to Human Resources each time there is a change in status)
Initial Hire Change of current information HR Use Only _____________________
Legal name must match SS card
First
Middle
Last
If submitting name change,
indicate former name
Pay Check
Mailing Address
Home
Phone
City
State
Zip
Code
County
SS
Number
Cell
Phone
Work
Email
Personal
Email
Date of Birth
Race
Male Female Married Single Mr. Mrs. Ms. Dr.
Spouse’s
Name
Date of
Marriage
Spouse’s Date
of Birth
Institution
Name
Highest
Degree
Major
Date
Received
Name of Relative(s)
Employed at UWG
Department
Relationship
Emergency
Contact
Phone
Number
Relationship
*Prior University System of GA
Employment (Institution/Agency)
Title
Date
From
Date
To
*Please Note: If you are employed with a Board of Regents of the University System of Georgia Institution such as the University (herein referred to as
a “System Institution”), then you may not also simultaneously be employed by another System institution. However, you may serve as a consultant to
another System institution, if you have on file with the University of West Georgia a prior completed and executed “University System Consultant
Services Agreement Between Institutions,” which must be signed by the Presidents of both System institutions and the Chancellor for the Board of
Regents in the University System of Georgia. You may not simultaneously be employed or serve as a consultant with a System institution and another
State of Georgia Executive Branch agency, unless you have on file with the University of West Georgia a prior completed and executed Joint Staffing
Letter Agreement. If you are employed by a System institution, ordinarily, you may not also be employed by or serve as a consultant to another State of
Georgia agency which is in either the legislative or Judicial Branch of State Government.
Signature
Date
