Join the GW Pride

Apply Now

The George Washington University is required by law to maintain records of your employment.  The information requested below will become part of your employee record and will be confidentially maintained.  You are asked to furnish all the information requested below.  If any item is not applicable to you, please write N/A in the appropriate space.



Information below must match legal documentation (i.e. I-9 or Social Security Card)

Last Name

First Name

M.I.

Date of Birth (mm/dd/yyyy)

 Phone

 Email (where University ID will be sent)
Position Title

 Date of Hire
Gender
F M
 Marital Status
Divorced Married Single
Separated Widowed
Have you been affiliated (Student, Faculty, Staff, Affiliate) with GW before Yes No
GWID (if known)
 Other name you may have had while previously been affiliated with GW (i.e. Maiden Name)
  

DEMOGRAPHIC DATA
Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, and our own college/university communities, to describe the ethnic/racial backgrounds of its students and employees. In order to respond to these requests, we ask you to answer question 1 and also question 2 as applicable:
Ethnicity
1.  Do consider yourself to be Hispanic or Latino (Persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?
Yes No
Race
2. In addition, you may select one or more of the following racial categories to describe yourself:

White (not Hispanic or Latino)

Black or African American (not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)

Asian (not Hispanic or Latino)

American Indian or Alaska Native (not Hispanic or Latino)

Citizenship Status:
check box that applies
  US - United States Citizen
  PR - Permanent Resident
  RF - Refugee
  NI - Non-Immigrant
 Veterans’ Status:
check all that apply
Non-Veteran
Other Protected Veteran
Vietnam Veteran Only
Both Vietnam/Other Elig. Vet
Date of Separation:

Armed Forces Service Medal Veteran
Special Disabled Veteran

 Disability Status:
check all that apply
None
Visual
Hearing
Mobility
Other*
*If other disability status, please list

Need a reasonable accommodation? Contact the EEO Department to make your request.

Are any relatives or members of your household currently employed with The George Washington University?
Yes No
Name

 Department Relationship to you
Name

 Department Relationship to you
Are you currently a GW student?
No Yes
 If yes:
Full-Time Part-Time

CAMPUS ADDRESS / EMERGENCY CONTACT INFORMATION
Campus (Primary Office Address, if known):
Name of Your Department
Campus Address
City

 State      Zip
Campus Phone

 GW Email Address (if known)
Work Location (Physical Office Location if Different from Campus Address i.e. Remote Location, if known):
Work Location Address
Work Location City

 Work Location State and Zip
Work Location Phone
Home Address:
Address
City

 State      Zip
Home Phone

 Home Email Address
Emergency Contact Information:
Name

 Relationship to You
Address
City
 State      Zip
Phone Number
 

Please report any changes to the information listed above to Human Resources.

Certification

I certify that the information submitted in this form is correct and complete to the best of my knowledge and belief.

BY SIGNING BELOW, I certify that I have read and understand these statements.(please type in your full name)