<p> EMPLOYEE PERSONAL INFORMATION FORM</p><p>Employee Full Name (Last, First, M.I.) Preferred Name</p><p>Primary Address (Mailing) City State County Zip Code</p><p>Supplemental Address City State County Zip Code</p><p>Gender Birth Date Marital Status Home / Cell Telephone Number [] Male [] Single ( ) ______h ______[] Female Month Day Year [] Married ( ) ______c</p><p>Emergency Contact Information </p><p>Name ______Address ______City ______State / Province ______Postal Code ______Country ______Relationship ______Cell Telephone ( )______Home Telephone ( )______Work Telephone ( )______</p><p>Employee Signature Date EIN</p><p>OPTIONAL INFORMATION *Detach Before Filing* Ethnic Code (Select One Only) Veteran Status Disability [] American Indian / Alaska Native [] No [] No [] Asian / Pacific Islander [] Veteran [] African American / Black [] Disabled Veteran [] Yes [] Hispanic [] White [] Unspecified</p><p>HRIS 110110</p>