employee master file
TRANSCRIPT
*IMPAQ’s finance department assigns File/Employee ID Number(s) to new hire.
EMPLOYEE MASTER FILE PERSONAL INFORMATION
Name
Salutation First Name MI Last Name Suffix
Date of Birth
Social Security Number
Gender o Male o Female
Marital Status o Single o Married
Ethnicity o Hispanic or Latino o Not Hispanic or Latino
Race o American Indian or Alaska
Native o Native Hawaiian of Other
Pacific Islander
o Asian o White
o Black or African American o 2 or more races
PERSONAL CONTACT INFORMATION
Address
Street Address/Apt
City County State Zip Country
Home Phone
Cell Phone
Email Address
VETERANS STATUS
VETS100 o Vietnam Era Veteran o Recently Separated (1yr)
o Special Disabled Veteran o None
o Other Protected Veteran
VETS100A o Armed Forces Service Medal
Veteran o Recently Separated (3yr)
o Disabled Veteran o None
o Other Protected Veteran
VISA STATUS (if applicable)
Visa Type
Visa Number
Visa Expiration
Citizen Of
I-9 Citizenship
I-9 Eligibility Review Date
*IMPAQ’s finance department assigns File/Employee ID Number(s) to new hire.
Completed by Human Resources Only
Original Hire Date
Job Title
Division o Corporate o Survey Center
Location Columbia Washington, DC California Hawaii Remote
Employee Type o Regular Full Time - 40 hrs
(benefits) o Regular Full Time 30-39 hrs (benefits)
o Regular Part Time
20-29 hrs (benefits) o Regular Part Time 20 hrs
o Temp Project Hourly o Intern Hourly
o Intermittent Hourly
FLSA o Exempt
o Salary
o Non-Exempt
o Hourly
Annual Salary
Bonus (if applicable, specify
amount & when payable)
Supervisor
Home Department
Weeks of Vacation at hire
Referred By
WORK CONTACT
Work Phone
Fax
Work Wireless
Email Address
This person will be a corporate supervisor
EMPLOYEE INFORMATION FORM (Please Print) SUBMIT COMPLETED FORM TO HUMAN RESOURCES
I. Basic Information Name (Last, first, middle initial):
Date:
Home Address:
Home Phone Number: Other Phone Number:
Date of Birth:
Date of Hire:
Name of Manager:
II. Emergency Contacts Name: Relationship:
Daytime Phone Number: Other Phone Number:
Name: Relationship:
Daytime Phone Number: Other Phone Number:
HUMAN RESOURCES
Dated submitted to Human Resources: Initials: _____________ Date:
DIRECT DEPOSIT ACCOUNT INFORMATION
I
Employee Name Deltek ID #
authorize the direct deposit of all/or part of my semi-monthly IMPAQ International payroll checks, to
the following account(s):
Name as it appears on the account
Account Number $ Amount Only (not %)
Checking Savings
Account Number $ Amount Only (not %)
Checking Savings
Voided Check Attached: Letter from Bank Attached:
I understand IMPAQ International bears no responsibility once any funds have been deposited to this or
any account authorized by me. This information supersedes all previous account information.
Signature Date
Witness Date
New Employee Information
The information from this document is used for a public Staff Announcement. When completing this
form, include information/insight about yourself that you would like us to share with your colleagues.
Name
Date of Hire
University & Degree (fill in applicable fields)
University: B.A.
University: M.A.
University: Ph.D.
Years of Relevant Experience
Areas of Specialization (e.g. LTC, labor, health, etc.)
Quantitative Skills (e.g. Stata, SAS, etc.)
Qualitative Skills (e.g. Focus groups, surveys, etc.)
Languages
Additional Information (optional)