Employee Data Form (Confidential) Personal Data Name ________________________________________ Address _____________________________________ _____________________________________________ Home phone (_____) ___________________________ Emergency phone (_____) _______________________ Additional Personal Data Number children in district: _______ Now _______ Past _______ Grandchildren List family members employed by the Board (Name, position, & location): _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ List organizations of which you are a member: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ List relatives or friends who are community leaders (political/business/civic) _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 98 – AR Handbook List any talents/hobbies/special abilities: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Work Data Work location: ________________________________ Work phone (_____) ___________________________ Hours worked/day: _____ / _____ Hourly rate _______ Assignments: Elementary Middle High Vocational Shuttle Spec. Ed Other ________________________________________ Time: start ________ (am/pm): end ________ (am/pm) Actual working hours per week: __________________ Summer hours per week: ________________________ Average hours/month for Emergency/OT: __________ District resident? Yes No Total yrs. in district: _____ Living _____Working Number of accumulated sick days _________________ Years in pension plan ___________________________ Emergency response availability: 10 min. 20 min. 30 min. Training/Workshops/Seminars (examples: EMT, computer training, chemical safety, workplace safety, instructional skills, nutrition, etc./use extra sheet if needed). _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Check here if using another sheet for additional information that you feel is pertinent.
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