Type of Request: New Hire Rehire Address Change Legal Name Change
ERSONAL INFORMATION
Legal Last: First: Middle:
Name
Student or Employee ID Number: (if available)
Former Legal Name: (if requesting a Legal Name Change; a copy of your Social Security Card showing your updated name must be attached)
MM
DD
YYYY
Social Security Number: (new hires only)
National Provider Identifier/NPI: (Feinberg faculty physicians only)
Single Married
Female Male I don’t wish to answer
Northwestern University understands that the binary gender values
do not reflect the inclusive nature of the community at large, but
unfortunately external impacts have required this field to be limited.
Please select the option with which you feel most comfortable.
Visa/Residency: (non-U.S. citizens only)
F-1 J-1 H-1B Other: ____________
In which state will you be performing work for Northwestern?
Are you interested in contributing to the Northwestern University Voluntary
Savings Plan, a 403b pre-tax retirement savings plan? Yes No
Note: New hires must complete Form I-9 online (northwestern.I9servicecenter.com) by the end of their first day of work and provide required documentation to be employed
and paid. If you are not a U.S. citizen or permanent resident, contact fntax@northwestern.edu to complete information in the Foreign National Information System (FNIS).
ONTACT INFORMATION If you are an active employee changing your contact information, please do so online at myhr.northwestern.edu.
Home Address
Most official employment communication will be sent to this address,
including printed checks, tax forms, and benefits documents.
Secondary Phone Number: (optional)
Is this address part of on-campus student housing? Yes No
Remember to keep your contact information updated!
After you are hired, log into myHR and update your address when you move,
enter or leave on
-campus housing, or prepare to depart Northwestern. This
will ensure that important documents, such as paychecks and tax forms, are
delivered to you promptly.
EMOGRAPHIC DATA
Are you Hispanic or Latino?
Yes No
What is your race? (select one or more)
American Indian or Alaska Native Black or African American White
Asian Native Hawaiian or Other Pacific Islander
Non-Discrimination Policies: Northwestern University is committed to providing an environment free of discrimination, harassment, and retaliation. Please visit the
following websites to learn more about Northwestern’s non-discrimination policies and complaint processes: www.northwestern.edu/equity and
www.northwestern.edu/sexual-misconduct.
INSTRUCTIONS
or Rehire:
• Provide this form to your HR representative or hiring manager with the rest of your hire paperwork.
or Name Change:
• If you are a current employee requiring an address change, update your information online instead, at myhr.northwestern.edu.
• If you are submitting a name change, you must attach a copy of your updated Social Security Card for verification.
• Email this form to askHR@northwestern.edu
or mail/drop off the form at the Office of Human Resources, 1800 Sherman Ave, Suite 1-100, Evanston, IL 60201.
Administrators Hiring Temporary Employees:
• Review the information for hiring temporary employees at www.northwestern.edu/hr/for-managers/hiring/hire-temp-staff.
• Submit your hire request online at www.northwestern.edu/myhr/forms/document-submission.html and attach this form.
Questions about this form? Contact askHR@northwestern.edu ● rev. 10/12/2021
(not a U.S. citizen)
