Full Text
PLEASE RETURN FORM TO PERSONNEL REVISED 08/21/2018 EMPLOYEE INFORMATION SHEET GENERAL INFORMATION ADDRESS CHANGE YES □ NO □ EMPLOYEE LAST EMPLOYEE FIRST MIDDLE PREFERRED NAME (NICKNAME) STREET CITY, STATE, ZIP MAILING STREET OR PO BOX CITY, STATE, ZIP EMPLOYEE HOME HOME EMAIL OF BIRTH SOCIAL SECURITY HAVE YOU BEEN A MEMBER OF CALPERS (CALPERS PUBLIC EMPLOYEE RETIREMENT SYSTEM) YES NO IF YES, MEMBERSHIP START DATE: SEPARATION DATE: EMERGENCY CONTACT EMERGENCY CONTACT #1 NAME: PHONE CELL: EMERGENCY CONTACT#2 PHONE CELL: JOB INFORMATION TITLE: START HIRING WORK LOCATION: EMPLOYEE