KUHRPAY(9/14) www.payroll.ku.edu University of Kansas Employee Data Sheet Please type or print legibly. Information is keyed directly into the Human Resource/Payroll System from this form. Enter name as it is printed on your social security card Last/Family Suffix First Home (W-2) Address Street City Street Birthdate (MM/DD/YY) City State State Zip Zip County Phone County Phone If non U.S. Citizen - Indicate Birth Country Non-Tax Marital Status Gender (M/F) Less than High School Graduate Highest Education Level High School Grad or equivalent Bachelor's Degree Birth City Married Single 1-Year College KU Student ID 3-Years College 2-Years College Some Graduate School Email Address Primary Campus Work Location (Check One) Social Security Number Former Names Preferred Name (Directory Use) Mailing Address (if different) Middle 4-Years College Doctorate Master's Degree Technical School Post Doctorate Campus Work Phone KU Lawrence (DG) Edwards Campus, OP (JO) Juniper KGS Well Gardens, KC Library Wichita (WY) (SG) Parsons (LB) Talent Search, KC (WY) KLETC, Yoder (RN) Capital Center, Topeka (SN) KUMC, Kansas City (WY) KUMC, Wichita (SG) Other (City/State) : Citizenship Status Alien Temporary Permanent Resident Native Naturalized The State of Kansas uses a one-question format for reporting purposes. Please indicate your primary race: American Indian or Alaska Native (5) Asian/Pacific Islander (4) Black or African American (2) Hispanic (3) Are you Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White - not Hispanic (1) YES, Hispanic or Latino No, Not Hispanic or Latino In addition, choose one or more of the following racial categories to describe yourself: American Indian or Alaska Native: A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment. Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. Black or African American: A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Self-Identification: Military Status and Recently Separated Veteran (optional) If you believe you belong to any of the classifications of protected veterans, please indicate by selecting the appropriate option below. (See Invitation to Self-Identify Disable and/or Veteran Status for descriptions). Disabled Veterans, please fill out the additional form Disclosure Form for Persons with Disabilities I identify as one or more of the classifications of protected veteran listed: Disabled Veteran Recently Separated Veteran Military Discharge Date: Active Duty Wartime or Campaign Badge Veteran Armed Forces Service Medal Veteran I am a protected Veteran, but I choose not to self-identify the classification to which I belong I am not a protected veteran I am not a veteran Professional Education: Degree Employee Signature Date (MM/DD/YY) Major School Date: Country/State