Fillable Personal Data Sheet Name Citizenship Mr. Ms. Dr. (University of Central Florida)

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Personal Data Sheet Name Citizenship Mr. Ms. Dr. (University of Central Florida)

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Country of origin: US
File type: PDF

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EmplID: ______________
ePAF # ______________
REV 30Jul2019
Personal Data Sheet
Please print clearly and check all that apply.
New Hire: Personal Email Address:__________________________________________
Record Update: Send form via fax to 407-882-9047 or interoffice to HR, +0140. For name changes, include copy of Social Security Card.
Mr. Ms. Dr.
Name
Name as it appears on Social Security Card
Citizenship
Native Naturalized
Citizenship Country
Alien Permanent
Visa Type
Alien Temporary Work Auth. Exp. Date
Ethnic Group(s): Step 1: Choose One
Non-Hispanic
Hispanic
Ethnic Group(s): Step 2: Choose One or More Ethnicities
Black or African American White American Indian/Alaska Native
Native Hawaiian or Other Pacific Islander Asian
If two or more ethnicities, please circle one as a primary
Gender
Male Female
Birth Date
(mm/dd/yyyy)
Marital Status
Divorced Married Single Widowed
Military Status
Not a Veteran
Recently Separated Vet
Armed Forces Svc Medal Vet
Disability
Yes No
Disabled Vet
Active Duty/Campaign Badge Vet Not a Protected Vet
Home Address
Physical Address
required. P.O. Boxes
will not be accepted.
Phone
Cell
Street
City
State
Zip
County
Country
Mailing
Address
Same as Home
Address
Street
City
State
Zip
County
Country
Public Records
Are you or your spouse a former or active law enforcement officer, a former or active
civilian personnel employed by a law enforcement agency, judge, or member of a
protected class under Florida Statute 119?
Yes No
Employment of
Relatives
Do you have any relatives who are currently employed by UCF? Persons who intend to marry, or
with whom the employee intends to form a domestic partnership or other intimate relationships are
included in the definition of relative. If yes and the relative works within the same unit, department,
or college, an Employment of Relatives form must be completed and approved prior to employment
.
Relative’s Name:_______________________________________
Relative’s Department: _______________________________
Yes
No
Signature:
Date:
click to sign
signature
click to edit
REV 30Jul2019
Personal Data Sheet
Ethnic Groups
White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black or African American: A person having origins in any of the black racial groups of Africa.
Hispanic: A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin,
regardless of race.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
Subcontinent. This includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South
America (including Central America), who maintains cultural identification through tribal affiliation or community
attachment.
Native Hawaiian or other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.
Military Status
Not a Veteran: a person who has not served in active duty with any branch of the United States Armed Forces.
Recently Separated Veteran: any veteran during the three-year period beginning on the date of such veteran’s
discharge of release from active duty in the U.S. military, ground, naval, or air service.
Armed Forces Service Medal Veteran : A veteran who, while service on active duty in the U.S military ground,
naval, or air service, participated in a United States military option for which an Armed Forces service medal was
awarded pursuant to Executive Order 12985.
Disabled Veteran: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or
who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the
Secretary of Veteran Affairs; or a person who was discharged or released from active duty because of service-
connected disability.
Active Duty Wartime or Campaign Badge Veteran: A veteran who served on active duty in the U.S military,
ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been
authorized under the laws administered by the Department of Defense.
Not a Protected Veteran: a person who DOES NOT fall under the protected veteran status of 1) Recently Separated
Veteran 2) Armed Forces Service Medal Veteran 3) Disabled Veteran 4) Active Duty Wartime or Campaign Badge
Veteran.
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Personal Data Sheet Name Citizenship Mr. Ms. Dr. (University of Central Florida)

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Completed 4 January 2021

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