Employee Record Form


Personal Details


First Name

Middle Name

Last Name


Street Address

Street Address Line 2


City

State


Postal Code


Phone Number

Mobile Number


Email:


Date of Birth

Age


SSN

Sex


Martial status 


Spouse’s Name

Spouse’s Phone


Employee Medical Conditions


Employment History (start with the last one first)

Company Name

Address

Position

Starting Date

Ending Date

Starting Salary

Ending Salary

Reason for Leaving

1
 
 
 
 
 
 
 
 
2
 
 
 
 
 
 
 
 
3
 
 
 
 
 
 
 
 
4
 
 
 
 
 
 
 
 
5
 
 
 
 
 
 
 
 

Emergency Contact

Name

Phone

Alternate Phone

Relationship

 
 
 
 
 
 
 
 
 
 
 
 

Notes

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