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Full Legal Name: Home Address: City, State, Zip: Home Phone: Spouse’s Name: Preferred Name (if different): Date of Birth: Gender: ☐Male ☐Female Social Security Number: ☐Salaried Annual Rate: ☐Hourly Hourly Rate: Work Type: ☐8842 (works with children) ☐8810 (does not work with children) ☐Full Time ☐Part Time Hours per pay period: ☐On Call Benefits: ☐Yes ☐No PTOs: ☐25 ☐28 ☐30 ☐35 Ordained Minister: ☐Yes ☐No Pay Type: Job Title: Department number: Personnel History Years Experience at Hire: Education Level at Hire: Salary Determination: Base Education Experience Location: Additional Resp: Totally Salary: Comments: Supervisor Approval: Date: .
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