New Employee Tech Access Form

 

First Name _______________ Middle Name ________________ Last Name ________________

 

Name you go by __________________________________

Date of Birth _______________________

Social Security Number ________________________________

Race/Ethnicity (Please Circle All that Apply):

 

American Indian/Alaska Native

Asian

White 

Black/African American

Native Hawaiian/Other Pacific Islander

Hispanic/Latino

Home Address __________________________________________________________________

                                                     Street/Apt/ City/ State /Zip

 

Home Phone Number ( ______)____________________

Cell Phone Number ( ______) _____________________

 

Circle One:  Full Time      Part Time                 Substitute

 

Position/Title _________________________________________

Workplace Location (Circle All That Apply): Board Office     MES      MMS       MHS       Bus Garage

Date of Hire ____________________________________

Have you been employed by our district previously? Yes No

Were you ever a student in our district? Yes No If yes, what year did you graduate/leave? _______

Do you currently or have you ever had children that attended our school district? Yes No

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Office Use Only (Check when Complete, put N/A if not applicable)

AD_______

Google___________

Email Groups____________

IC____________

Tech Ticket____________

GoGuardian____________

KnowBe4______________

Badge_______________

Chromebook___________
Assigned____________