Demographic Information for New Staff Members
Congratulations on accepting a position with the University of Puget Sound. Please provide the
following information as soon as possible in order to establish a payroll record and implement
network access.
Legal Name: __________________________________________________________________
(As stated on your Social Security Card)
First
MI
Last
Preferred Name: ______________________________________________________________
Mailing Address:
_____________________________________________________________
Street
(Apt #)
_______________________________________________________________________
City
State
Zip
Home Phone: (_______)________________ Mobile Phone: (_______)________________
Personal Email: __________________________________________________________________
Gender:
Female
Male
Date of Birth: _____________________________
In case of an emergency please notify:
_______________________________________________________
Name
__________________
Relationship
_______________________________________________________
Address
City/State/Zip
(_____)____________
Phone