University of Kansas Employee Data Sheet

KUHRPAY(9/14)
www.payroll.ku.edu
University of Kansas Employee Data Sheet
Please type or print legibly. Information is keyed directly into the Human Resource/Payroll System from this form.
Enter name as it is printed on your social security card
Last/Family
Suffix
First
Home (W-2)
Address
Street
City
Street
Birthdate
(MM/DD/YY)
City
State
State
Zip
Zip
County
Phone
County
Phone
If non U.S. Citizen - Indicate Birth Country
Non-Tax Marital Status
Gender (M/F)
Less than High
School Graduate
Highest
Education
Level
High School Grad
or equivalent
Bachelor's Degree
Birth City
Married
Single
1-Year
College
KU Student ID
3-Years
College
2-Years
College
Some Graduate School
Email Address
Primary Campus
Work Location
(Check One)
Social Security Number
Former Names
Preferred Name (Directory Use)
Mailing Address
(if different)
Middle
4-Years
College
Doctorate
Master's Degree
Technical
School
Post Doctorate
Campus Work Phone
KU Lawrence
(DG)
Edwards
Campus, OP
(JO)
Juniper
KGS Well
Gardens, KC Library Wichita
(WY)
(SG)
Parsons
(LB)
Talent
Search, KC
(WY)
KLETC,
Yoder (RN)
Capital Center,
Topeka (SN)
KUMC,
Kansas City
(WY)
KUMC,
Wichita (SG)
Other (City/State) :
Citizenship Status
Alien Temporary
Permanent Resident
Native
Naturalized
The State of Kansas uses a one-question format for reporting purposes. Please indicate your primary race:
American Indian or
Alaska Native (5)
Asian/Pacific
Islander (4)
Black or African
American (2)
Hispanic (3)
Are you Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South
or Central American, or other Spanish culture or origin regardless of race.
White - not Hispanic (1)
YES, Hispanic
or Latino
No, Not Hispanic
or Latino
In addition, choose one or more of the following racial categories to describe yourself:
American Indian or Alaska Native: A person having origins in any of the original peoples of North and South American
(including Central America), and who maintains tribal affiliation or community attachment.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent,
including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Black or African American: A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Self-Identification: Military Status and Recently Separated Veteran (optional)
If you believe you belong to any of the classifications of protected veterans, please indicate by selecting the appropriate option below. (See Invitation to Self-Identify Disable and/or
Veteran Status for descriptions). Disabled Veterans, please fill out the additional form Disclosure Form for Persons with Disabilities
I identify as one or more of the classifications of protected veteran listed:
Disabled Veteran
Recently Separated Veteran
Military Discharge Date:
Active Duty Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
I am a protected Veteran, but I choose not to self-identify the classification to which I belong
I am not a protected veteran
I am not a veteran
Professional Education:
Degree
Employee Signature
Date (MM/DD/YY)
Major
School
Date:
Country/State