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SAMFORD UNIVERSITY Human Resources (Samford University)

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SAMFORD UNIVERSITY
Human Resources
Personal Information Form
Name: Preferred First Name:
Title:
Mr. Mrs. Ms. Dr. Other: _______________
Are you an ordained minister? Yes No If yes, which denomination? _____________
EEO Information:
Male ____ Female Are you Hispanic or Latino?
Yes No
What is your race group? (One or more entries are allowed)
Date of Birth ____________
___ Asian
___ Black or African American
___ American Indian/Alaskan Native
___ Native Hawaiian or Other Pacific Islander
___ White
Contact Information:
Street Address City/State Zip Code
Home Phone Number Cell Phone Number Email Address
Emergency Contact Name Relationship Phone Number
Include Personal Address and Phone Numbers in Samford University Online Directories? ____ ____
Yes No
For Human Resources Use Only:
___ Campus Address ___ Perm. Address ___ Emergency Contact ___ S.S. Name
Revised: 4/18
RESET RACE GROUP
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SAMFORD UNIVERSITY Human Resources (Samford University)

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Completed 26 August 2020

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