INFORMATION SHEET FOR PERSONNEL ACTIONS
Name:
First
M. Initial
Last
Permanent Home Address:
Street or P.O. Box
Home Phone:
(
City
)
Area Code
&
Date of Birth:
/
number
Local
Phone:
Local Mailing Address:
Month
Day
(
)
STUDENT ENROLLMENT:
Clemson Student?
Yes
No
Full-time Undergraduate
Full-time Graduate
Sex:
Male
Education:
2-Yr College
Bachelors
Doctorate
HS Grad
Master’s
MD, DDS, JD
Not Indicated
Female
Marital Status:
Single
Married
Divorced
Separated w/o divorce
Widowed
Are you working anywhere else on campus?
YES
NO
Are you currently a member of the S.C. Retirement System?
Military Status: (Please check one)
No Military Service
Date of Separation
/
Month
Disabled Veteran:
YES
Year
Email:
Part-time Undergraduate
Part-time Graduate
Post-Doct
Some College
Some Grad
Tech School
*If you’re not a U.S. Citizen,
what is your nationality?
YES
None
Other Vet
NO
Active Reserves
Inactive Reserves
Retired
Viet Vet
Please check one:
H (Honorably discharged)
D (Dishonorably discharged)
Year
NO
Disabled:
YES
Emergency Contact:
State:
Name:
/
Month
Type of License:
/
Day
Car
Motorcycle
to
Year
/
Month
NO
Relationship
/
Day
Cr(s). Taking
Citizenship Status:
Alien Perm.
Alien Term.
U.S. Citizen
Naturalized
Driver’s License Info:
#
Date Valid from
Country
Race:
If yes, where?
/
Day
State & Zip
/
Address:
Year
City:
Phone #:
Truck
Chauffer
State:
(
Area Code
Phone #:
Zip Code:
)
(
& number
Type
& number
Type
)
Area Code
**********************************************************************
Hiring Departmental Use Only:
Administrative
Non-Tenure Track
Supervisor Name:
Faculty
Effect. Hire Date:
Staff
Tenure-Track
Dept Number
Temporary
Tenured
Grad Student
Undergrad Student
Penultimate Year
Supervisor ID/Position No.: