ÑÇÖÞÓ°Ôº

Please follow these instructions for completing your Personal Data Form. If you have questions about completing the form, check with your supervisor or Human Resources Office for assistance.

1. Complete if known. This is the unique 8 digit number used to identify each employee.
   Example: 01011001
2. Write in the effective hire date or date of change to personal information.
   Example: mm/dd/yyyy
3. Check (X) the box that indicates how you prefer to be addressed. Write your name in the boxes provided as it appears on your social security card
4. Write in the date you were born. Example: 12/01/1963 for December 1, 1963
5. Check (X) the box which indicates your gender.
6. Check (X) the box that describes the highest level of education which you HAVE COMPLETED.
7. Check (X) the box which describes your marital status.
8. Write in your Social Security Number. Example: 000-00-0000

Contact Information

9. Write in the address where you currently reside. For students living on campus, this address will be a residence hall.
10. Provide a mailing address if you want to receive mail at an address other than where you currently reside. If you provide a mailing address, it will be used for mailing your W-2.
11. - 12. Provide your complete work address including zip code. A street address is not required for buildings on campus.

13. Write in your home telephone number, including area code.
    Example: (573) 555-0000 
14. Write in your University work telephone number, including area code. 
    Example: (573) 882-0000

Regional Information

15. Check (X) the box which best describes your ethnic origin.
16. Federal law requires the University to report the number of employees who fall into categories listed. Check all that apply. (See URL  for further information).
17. Write in date of discharge from military, if applicable.

UM Specific

18. Check "Yes" if you will be working with or around animals that are used for research or teaching, or if you will be handling research/teaching animal tissue or fluids.
19. Check if you want to restrict the release of your home address and home telephone number i.e., it will not be released unless required by law or University policy. 

Emergency Contact

20. Write in the name of an individual who may be contacted on your behalf in the event of an emergency. Include this person's telephone number including area code

Citizenship

21. Check (X) the box which best describes your citizenship status in the U. S.
22. Complete only if you are a Non-Resident Alien or Permanent Resident. 

Required For Academic Employees Only

23. Write in the name of the highest degree you have earned, whether it is a terminal degree (yes or no), the date the degree was granted and major emphasis of the degree. Write in the name and location (city and state or country) of the institution which awarded your highest degree.