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Dutch Springs Employee Information Sheet

This is an overview of all Employee Information.

For HR Only

      Employee Number: __________          Pay Rate: __________        SSN ______ - _____ - __________

First Staff's Name

First Name*

Middle Name

Last Name*
First Staff's Date of Birth*
First Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
First Staff's Signature*
Second Staff's Name

First Name*

Middle Name

Last Name*
Second Staff's Date of Birth*
Second Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Third Staff's Name

First Name*

Middle Name

Last Name*
Third Staff's Date of Birth*
Third Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Fourth Staff's Name

First Name*

Middle Name

Last Name*
Fourth Staff's Date of Birth*
Fourth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Fifth Staff's Name

First Name*

Middle Name

Last Name*
Fifth Staff's Date of Birth*
Fifth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Sixth Staff's Name

First Name*

Middle Name

Last Name*
Sixth Staff's Date of Birth*
Sixth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Seventh Staff's Name

First Name*

Middle Name

Last Name*
Seventh Staff's Date of Birth*
Seventh Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Eighth Staff's Name

First Name*

Middle Name

Last Name*
Eighth Staff's Date of Birth*
Eighth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Ninth Staff's Name

First Name*

Middle Name

Last Name*
Ninth Staff's Date of Birth*
Ninth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Tenth Staff's Name

First Name*

Middle Name

Last Name*
Tenth Staff's Date of Birth*
Tenth Staff's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Staff's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Hire Date *
Marital Status*
Single
Married

Township or Borough Employee Resides In *

Home Phone Number

Cell Phone Number *

Other Phone Number
T-Shirt Size (Adult)*
Primary Department*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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