New Hire Information Request Personal Information Due to Federal educational law concerning the privacy of educational records, the department will correspond with you at your University email address. Last Name * Family name. First Name * Middle Name Chosen Name What you prefer to be called. University ID (UNID) u1234567 Date of Birth * Month/ Day/ Year Telephone Number * (xxx) xxx-xxxx Email * Preferred University Email Employment Status, select one. * Alien TemporaryCitizenPermanent Resident Utah Physical Address Street Address * 123 Lincoln Street, Apartment A City * Salt Lake City State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * 84112 Emergency Contact Name * Relationship * Telephone * (xxx) xxx-xxxx Street Address * 123 Lincoln Street, Apartment A City * Salt Lake City State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * 84112 Identity Information Gender * FemaleMaleUnknown Martial Status * SingleMarriedCivil PartnerCivil Partner; Deceased.Married; Separated.DivorcedWidowedHead of HouseholdUnknown Highest Education Level * Associate DegreeBachelor's Nursing (BSN)Bachelor's Level DegreeDoctorate (Academic)Doctorate (Professional)High School Graduate or EquivalentLess Than High School GraduateMaster's Nursing (MSN)Master's Level DegreeNot IndicatedPost-DoctorateSome CollegeSome Graduate SchoolTechnical School Ethnicity (optional): Are you Hispanic or Latino? Yes No What is your race? (Select one or more._ American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White reCAPTCHA If you are human, leave this field blank. Δ
