Employment Information Request Form
Employee ID number
Name of Employee
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Gender
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Next
Job Code
Job Title
Department
Supervisor's Name
First Name
Last Name
Supervisor's Email
example@example.com
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Next
Hired Date
-
Month
-
Day
Year
Date
Contract Date
-
Month
-
Day
Year
Date
Recruitment Type/Code
Please Select
Full-Time Employee
Part-Time Employee
Temporary Employee
Seasonal Employee
Employee Status
Please Select
Active
Non-active
End of Contract
Terminated
Hourly Rate ($)
Department requesting employee records
Please Select
Human Resources
Accounting
Security
Head Office
Others
Authorized Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: