SUNY ESF
Employee Questionnaire

Please don't fill out this input box.

• New employees are required to complete this full form, then sign and date at the bottom
• Returning employees are required to fill in name and anywhere changes have occurred, and then sign and date at the bottom; if no changes, 

Fill in the name and check the box, then sign and date at the bottom

There are no changes

Preferred Salutation

Dr.

Ms.

Mrs.

Miss

Mr.

Sex

Male

Female

Gender Identity

Male

Female

X

Social Security Number*

Date of BirthMM/DD/YYYY

Full Name

Other Name (if applicable)

Permanent Address

Campus Address

Campus Email Address

Phone

U.S. Citizen

Yes

No

If not a US citizen, mention the VISA type

Country of Birth

Are you Hispanic or Latino

Yes

No

Regardless of your answer to the prior question, please indicate how you identify yourself. (Select one or more)

Black or African American

Native American or Alaska Native

White

Asian

Native Hawaiian or Other Pacific Islander

Emergency Notifications

Name

Relationship

Address

Phone

Acknowledgement

I hereby certify that the above information is true and accurate to the best of my knowledge. I understand that intentional or negligent falsification of the above information and/or information on the attached resume could lead to my dismissal.

Print Name

Date

Form UUID Site Name Submit  Clear