Employee Information Form

This form is designed to collect essential contact and emergency information for each employee, ensuring that we can reach you or your designated contact in case of an emergency. Please fill out the form completely and update it as necessary.

Employee Information

• Full Name: ___________________________________________

• Position: ___________________________________________

• Department: ___________________________________________

• Date of Hire: ___________________________________________

• Date of Birth: ___________________________________________

• Social Security Number (SSN): ____________________________

Contact Information

• Home Address: ___________________________________________

City: _______________________ State: __________ ZIP: ________________

• Phone Number (Primary): ____________________________

• Phone Number (Secondary): ____________________________

• Personal Email Address: ____________________________________

Emergency Contact Information

Primary Emergency Contact:

• Full Name: ___________________________________________

• Relationship to Employee: _______________________________

• Phone Number (Primary): ____________________________

• Phone Number (Secondary): ____________________________

• Email Address: ______________________________________

Secondary Emergency Contact (Optional):

• Full Name: ___________________________________________

• Relationship to Employee: _______________________________

• Phone Number (Primary): ____________________________

• Phone Number (Secondary): ____________________________

• Email Address: ______________________________________

Additional Information

• Allergies or Medical Conditions: (Optional) _______________________________

• Preferred Hospital: _____________________________________

Acknowledgment

I acknowledge that the information provided is accurate and up-to-date to the best of my knowledge. I understand that it is my responsibility to inform [Company Name] of any changes to this information.

Employee Signature: ____________________________________
Date: ______________________