Download Employee Information

Employee Information
Employee Name: __________________________________________________________________
Department: ______________________________________________________________________
Emergency Contact Information:
Name: ___________________________________________________________________________
Relationship: ______________________________________________________________________
Daytime Phone Number: _____________________________________________________________
Evening Phone Number: ______________________________________________________________
Cell Phone Number: _________________________________________________________________
The information requested below is used by Campbell University only to maintain records required of
employers doing business with the federal government. YOU DO NOT HAVE TO ANSWER THESE
QUESTIONS AS PART OF YOUR EMPLOYMENT WITH CAMPBELL UNIVERSITY. If you do choose to answer
these questions, any information supplied by you on this voluntary self-identification form will not affect
you employment opportunities with Campbell University, which is an equal employment
opportunity/affirmative action employer.
FOR REPORTING PURPOSES ONLY
Ethnicity:
Hispanic or Latino __
White (not Hispanic or Latino) ___
Black or African-American (not Hispanic or Latino) ___
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) ___
American Indian or Alaska Native (not Hispanic or Latino) ____
Two or more races (not Hispanic or Latino) _____
Asian (not Hispanic or Latino) _____
Do not wish to disclose ______
Gender: ____ Male ____ Female
____ Do not wish to disclose