Document Sample
					                      PEOPLESOFT PROCEDURES
                 PERSONAL DATA/CHANGE FORM (HR-100)

  This form is used to input personal information for new hires into the
  HR/Payroll PeopleSoft system or to make changes into existing personal
  information in the employee record in PeopleSoft.

  *Please make sure that a change in Name, Social Security #, Citizenship and
   Marital Status requires supporting documentation and may require changes
   for tax or benefit purposes – an appointment should be made in Human
   Resources when this change occurs.


  1. Indicate whether: New Hire or Change

  2. Indicate if change: Name, Address or Other

  3. NYMC ID#: for current employees, type ID number; leave blank for new hires.

  4. Effective Date: Indicate effective date of new hire or change.

  5. NYMC Relationship: scroll down and choose: Employee, Volunteer or


  6. *Name (last {space} suffix, first, middle)- if change* (attach supporting

  7. Prefix: choose: Mr., Mrs., Ms., Dr., Msgr., Rev. Msgr., Fr, Deacon, Hon., or Rev.

  8. *Employee SS#: put in 9-digit social security number, no spaces or dashes

  9. Home Street Address: put in street address or change of address

  10. City: put in city of home address

  11. State: put in state of home address

  12. Zip: put in zip code of home address
  13. County: put in County of Home Address

  14. Date of Birth


  14. Primary Work Location: put in work location of home department in primary job.

  15. Secondary Work Location: put in work location of department of secondary job.

  16. Indicate: New Hire Telephone Number or Change Telephone Number

  17. Phone Type: scroll down to: Home, Cell, Work, Work Fax.

  18. Phone Type: scroll down to: Home, Cell, Work, Work Fax.

  19. Phone Type: scroll down to: Home, Cell, Work, Work Fax.

  20. Phone Type: scroll down to: Home, Cell, Work, Work Fax.


  21. Emergency Contact: indicate New Hire or Change

  22. Emergency Contact Name: put first and last name of emergency contact.

  23. Street Address: put in street address of emergency contact.

  24. City: put in city address of emergency contact.

  25. State: put in state address of emergency contact.

  26. Zip: put in zip code of emergency contact.

  27. Phone Type: Indicate phone type of emergency contact: home or cell.

  28. Number: indicate phone number (area code, plus number)

  29. Phone Type: indicate additional phone type for emergency contact: home or cell.

  30. Phone Number: indicate additional phone number for emergency contact.

   31. Education Level: scroll to choice using Sheet I
   32. Gender: scroll to Male or Female.

   33. EEO Code: select respective race.

   34. Foreign Lang: write in language other than English, and scroll to read, write, or

   35. Veteran: scroll to yes or no.

   36. Disabled: scroll to yes or no.

   37. *Citizenship: scroll to US citizen, Resident Alien, Non Resident Alien J Visa,
       Non Resident Alien H Visa, Non Resident Alien F Visa, Non Resident Alien O
       Visa, Employment Authorization. And put in expiration date, if applicable.

   38. *Marital Status: scroll to married, single, divorced, other. If this is a
       change, include supporting documentation.

   39. NYMC Student: if student, scroll to Former or Current, if not leave blank.

  *Attach supporting documentation and if student also send copies to Registrar*


Signature of employee, consultant or volunteer and date.

Signature of Administrator/Dept Head and date (if applicable).

Department Name.