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New Employee Information Request Form - POSITION QUESTIONNAIRE FOR

By Amanda Phillips,2014-06-17 05:29
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New Employee Information Request Form - POSITION QUESTIONNAIRE FOR ...

    Today’s Date The University of Texas at San Antonio

     / / New Employee Information Request Form

    With few exceptions you have the right to request, receive, review and correct information about yourself collected using this form. Employee Name: EID: Marital Status: Married Single Gender: Male Female Birth Date: / /

    EEO Minority Code:

     Question One: Are you Hispanic or Latino? (a person of Cuban, Mexican, Question Two: Please select the Puerto Rican, South or Central America, or other Spanish culture or racial category or categories with whch

    you most closely identify. Check as many origin, regardless of race). Yes No as apply. -American Indian or Alaskan native ? If you answered “Yes” to Question One, then Question Two is optional. -Asian You can stop here or proceed to Question Two at your discretion. -Black or African American ? If you answered “No” to Question One, please answer Question Two. -Native Hawaiian or

     Other Pacific Islander

     -White Highest Less than high school Baccalaureate Degree Special professional Education High School / GED Master’s Degree (M.D., D.V.M., etc) (Please Level: Associates Degree Doctoral Degree specify)

    Veteran Statuses U.S. Citizen:

    (Please review the definitions on page 2 of this document. Yes No Check all that apply) If No, enter Visa information below) I am not a veteran or a surviving spouse of a veteran or an orphan of a veteran. Visa Type: Texas Veteran Federal Veteran Categories Exp. Date: / / (Please respond in sections A and B) Information Section A - Categories under Categories under Section B - MM / DD / YYYY Vietnam Era Veterans’ Readjustment Jobs for Veterans Act of 2002 Veteran Assistance Act of 1974 Surviving Spouse of Military Service Dates Vietnam Era Armed Veteran Please provide Military Service dates if either Special Disabled Veteran Forces Service Medal Orphan of Newly Separated Veteran status or Recently Other Protected Veteran Veteran a Veteran Separated Veteran status is selected. Newly Separated Veteran Disabled Veteran From: / Other Protected Veteran Veter

     To: / MM / an

     Recently Separated YYYY Prior Texas State Service: Note: Prior State Service could impact your Longevity Pay and Vacation

    Leave

    Previously employed by a Texas State agency: Yes