All Employees Complete
Prefix Last Name (incl suffix, e.g. Jr, Sr, III) First Name Middle Name
Personal Information
Connors State College
Complete form and send to Human Resources
700 College Rd, Warner, OK 74469
Status:
Check if Name Change
& attach a copy of your
new social security card.
All NEW Employees Complete - Current Employees, Enter only fields that need updated
Marital Status
Gender
Hispanic?
White Black
Asian American Indian / Alaskan Native
Native Hawaiian or Pacific Islander
Birth Date (MMDDYYYY)
Permanent Home Address (within USA)
Address Home Phone (w/ AC)
City
State
Zip Code
Personal Email Account:
Emergency Contact
Contact Name Contact Relationship
Contact Address (Street Address, City, State, Zip Code)
Contact Work Phone (w/ AC)
Contact Home Phone (w/ AC)
All NEW Faculty and Regular Staff Employees Must Complete
Educational Background **** List your HIGHEST degree or diploma first ****
Degree Year Rec'd Institution Name and Location Field of Study
Years of Teaching Experience
Years in Higher Education
Check any Applicable:
Special Disabled Veteran
Vietnam Veteran
Other Eligible Veteran
Disabled / Reasonable accommodation needed
This form only changes the basic employee demographic information in HRS and does not update benefits or
beneficiary information or other university systems.
Employee Signature Telephone Number Date
Human Resources
Coding Initials Date
