EMPLOYEE DATA FORM
(ALL DATA MUST BE COMPLETED FOR PAYROLL PROCESSING)
*Last Name:_________________ First Name:__________________ MI:____ Known By:____________________
Address:______________________________________________________City:__________________________
State:________ Zip:___________ Phone: ___________________ Male Female
Title: Mr. Mrs. Miss Ms. Dr. Rev. Sr. Suffix: DDS PhD MD SJ Jr.
Social Security Number: ________________ Date of Birth: ___________ Status: Single Married
Department:___________________________ Hire Date: _______________
Registered Disabled: Yes No Religion: Baptist Cleric Religion: Not Applicable
Buddhist Jesuit
Catholic Non-Jesuit Catholic Clergy
Veteran Status: Not a Veteran Eastern Orthodox Other Non-Catholic Clergy
Disabled Veteran Episcopal/Anglican Women Religious
Disabled Vietnam Veteran Evangelical
Vietnam Veteran Hindu
Other Eligible Veteran Jewish
Other Eligible Disabled Veteran Lutheran
Methodist
Separation Date:_____________________ Muslim
Other Christian
Other Non-Christian
Presbyterian
UCC
Not Applicable
Ethnic Origin: Are you Hispanic or Latino?
Yes, I am Hispanic or Latino
No, I am not Hispanic or Latino
No matter what you selected above, please continue to answer the following question.
What is your Race? (Select one or more)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Highest Degree Obtained: High School GED/HED Associate Bachelor Master PhD DDS MD JD
Date Received:______________________ Institution Name:__________________________________
Emergency Contact Name:_____________________________ Contact Address:___________________________________
Contact Phone Number: _________________ Relation to Employee:___________________
Send completed form to Human Resources IMMEDIATELY (Before Date of Hire) by email, fax or regular mail
Marquette University, Department of Human Resources, Straz Tower Rm. 185
P.O. Box 1881
Milwaukee, WI 53201-1881
(414)288-7305 Fax: (414)288-7425
Email: humanresources@marquette.edu
HR 11/11
* If you have previously
been issued an MUID and
your name has changed,
you must submit a Name
Change Request Form,
available from the MU
Central web site. A
Marquette University
Identification Number
(MUID) is issued to
students, student
applicants, parents, and
employees.
