pro-employee-data-sheet1

							Employee Data Sheet
Employee Name: _______________________Last _____M.I ____________________First Address: ___________________________ ___________________________ Home Telephone: __________________ Other Telephone: __________________ Driver’s License #: ______________________ State Issued: _________

DOB: __________________ SSN: __________________

Emergency Contacts:
1) Name___________________ _____ Relationship___________________ 2) Name___________________ _____ Relationship___________________ 3) Name___________________ _____ Relationship___________________ Contact #_______________________ Secondary Contact #______________________ Contact #_______________________ Secondary Contact #______________________ Contact #_______________________ Secondary Contact #______________________

Physician: _________________

Location and/or Phone #: __________________________

Driver’s License or Photo ID Copy

Hire Date: _____________ W4 Allowances: ________ Insurance Types: ________ ______________________ Uniform: Yes No