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.