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Personal Information Form

Human Resource Services

CHECK APPROPRIATE BOX : STATUS :
9 New Hire - must complete sections 1,2,3, and 5 (ifapplicable) 9 Faculty 9 Administrator 9 Letter of Appointment 9 Contract Professional
9 Change - complete only Section 1 for the following changes: 9 Coach 9Staff 9 Student 9 Teaching/Research Assistant
9 Name Change 9 Home Phone Change
9 Address Change (effective________________________ 9 EmergencyContact Information Change 9 UM Directory Change

|SECTION 1. Note: Address is available to view by all U of M Banner System users.|
|PLEASE PRINT |
|||Name__________________________________________________ Previous Name__________________________________ |
|(Last, First, Middle Initial) (If worked at the Univ under anothername) |
||
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|Name that appears on your social security card (if diff. than above)__________________________________________________ |
|...