Virginia State University New Employee Data Form (Please check one) Type of Employment: • Faculty Administrator • Faculty • Classified • Hourly • Adjunct Personal Data: Last Name: First Name: Middle Initial: Social Security Number: Home Phone: Personal Email Address: Gender: Date of Birth: Physical Address: (Street) P.O. Box: (for mailing only) (City) (State) (Zip Code) Credentials: (Please check highest level of education) • High School • Associates • Bachelors • Master’s • Doctorate Contact Information: In case of emergency: Contact Person: Relationship: Contact Phone Number(s): Race (Circle One): • • - White (includes Arabs) • • - Black (includes Jamaicans, Bahamians, and other Caribbean’s or African but not Hispanic or Arabian descent) • • - Hispanic (Spanish surname, includes Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Origin or culture) • • - Asian or Asian American (includes Pakistan, Indians, and Pacific Islanders) • • - American Indian and Alaskan Native Employee’s citizenship status (Check One): • U.S. Citizen - C • Resident Alien - A • Non-resident Alien – N Other Status: Nationality Code (See Back): ______________________________________________________ Prior State Employment: Yes _o / No • Please check one: Type of State Employment: • Faculty Administrator • Faculty • Classified • Hourly • Adjunct Dates: If yes, State Agency Name: (This information will only be used to ensure all employment records are transferred) Work Information: Position Title: Position Number (if known): Department: Supervisor’s Name and Title Campus Box No. : Building Location: Room # Work Number: VSU Email: Employee’s Signature 06/04/2007 If any information should change during your employment please contact HR NATIONALITIES: AF Afghanistan CT Central African Republic GG Georgia LG Latvia MU Oman WZ Swaziland AL Albania CD Chad GM Germany LE Lebanon SW Sweden AG Algeria CI Chile GH Ghana LT Lesotho PK Pakistan SZ Switzerland AQ American Samoa TW China (Taiwan) GI Gibraltar LI Liberia LQ Palmyra Atoll SY Syria AN Andorra CH China GO Glorioso Islands LY Libya PM Panama AO Angola KT Christmas Island GR Greece LS Liechtenstein PP Papua New Guinea TW Taiwan AV Anguilla IP Clipperton Island GL Greenland LH Lithuania PF Paracel Islands TI Tajikistan AY Antartica CK Cocos (Keeling) Islands GJ Grenada LU Luxembourg PA Paraguay TZ Tanzania AC Antigua & Barbuda CO Colombia GP Guadeloupe PE Peru TH Thailand AR Argentina CN Comoros GQ Guam MK Macedonia RP Philippines TO Togo AM Armenia CF Congo GT Guatemala MC Macau PC Pitcairn Island TL Tokelau Islands AA Aruba CW Cook Islands GK Guernsey MA Madagascar PL Poland TN Tonga AT Ashmore & Cartier CR Coral Sea Islands GV Guinea MI Malawi PO Portugal TD Trinidad & Tobago Islands CS Costa Rica PU Guinea-Bissau MY Malaysia RQ Puerto Rico TE Tromelin Island MV Maldives PS Trust Territory of the AS Australia IV Cote d’Ivoire GY Guyana QA Qatar AU Austria HR Croatia ML Mali Pacific Islands AJ Azerbaijan CU Cuba HA Haiti MT Malta RE Reunion TS Tunisia CY Cyprus HM Heard Island & IM Man, Isle of RO Romania TU Turkey BF Bahamas, The EZ Czech Republic McDonald Islands RM Marshall Islands RS Russia TX Turkmenistan BA Bahrain HO Honduras MB Martinique RW Rwanda TK Turks & Caicos Islands FQ Baker Island DA Denmark HK Hong Kong MR Mauritania TV Tuvalu BG Bangladesh DJ Djibouti HU Hungary MP Mauritius SC St. Kitts & Nevis UG Uganda BB Barbados DO Dominica MF Mayotte SH St. Helena BS Bassas da India DR Dominican Republic IC Iceland MX Mexico UP Ukraine IN India ST St. Lucia TC United Arab Emirates BO Belarus MQ Midway Islands SB St. Pierre & Miquelon BE Belgium EC Ecuador ID Indonesia MD Moldova Islands UK United Kingdom EG Egypt IR Iran VC St. Vincent & The US United States BH Belize MN Monaco Grenadines BN Benin ES El Salvad or IZ Iraq MG Mongolia UY Uruguay EK Equatorial Guinea EI Ireland SM San Marino UZ Uzbekistan BD Bermuda MW Montenegro TP Sao Tome & Principe BT Bhutan ER Eritrea IS Israel MH Montserrat EN Estonia IT Italy SA Saudi Arabia NH Vanuatu BL Bolivia MO Morocco SG Senegal BK Bosnia and ET Ethiopia MZ Mozambique VT Vatican City EU Europa Island JM Jamaica SR Serbia VE Venezuela Herzegovina JA Japan SE Seychelles BC Botswana WA Namibia VM Vietnam FK Falkland Islands (Islas DQ Jarvis Island NR Nauru SL Sierra Leone VQ Virgin Islands of the BV Bouvet Island Malvinas) JE Jersey SN Singapore BR Brazil BQ Navassa Island U.S. FO Faroe Islands JQ Johnston Atoll NP Nepal LO Slovakia IO British Indian Ocean FM Federated States of JO Jordan SI Slovenia WQ Wake Island Territory NL Netherlands Micronesia JU Juan de Nova Island NT Netherlands Antiles GP Solomon Islands WF Wallis and Futuna VI British Virgin Islands FJ Fiji SO Somalia WE West Bank BX Brunei KZ Kazakhstan NC New Caledonia FI Finland NZ New Zealand SF South Africa WI Western Sahara BU Bulgaria FR France KE Kenya SX South Georgia & the WS Western Samoa UV Burkina KQ Kingman Reef NU Nicaragua FG French Guiana NG Niger South Sandwich BM Burma FP French Polynesia KR Kiribati Islands YM Yemen BY Burundi KN Korea, Democratic NI Nigeria FS French Southern & NE Niue SP Spain CG Zaire Antarctic Lands Peoples Republic of PG Spratly Islands CB Cambodia KS Korea, Republic of NF Norfolk Island ZA Zambia CM Cameroon CQ Northern Mariana CE Sri Lanka ZI Zimbabwe GB Gabon KU Kuwait SU Sudan CA Canada GA Gambia, The KG Kyrgyzstan Islands CV Cape Verde NO Norway NS Suriname GZ Gaza Strip LA Laos SV Svalbard CJ Cayman Islands Page 2 of 2 01/01/2018 HR If any information should change during your employment please contact HR .