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Personal Data Form (PDF)

The purpose of a PDF is to maintain current personal data on an individual employee. The initial PDF establishes a new employee's database record.

The online version of the PDF has been made available for your convenience in submitting your information. Please use this form to submit a change in name, marital status, education, or address. Updates to an employee's record may be made as often as necessary. Please note that changes can be verified in UC Flex by viewing PA20. Please contact the Human Resources Service Center at email address: HR.

This is an online form; completing and submitting it will result in the requested change. By typing in your name in the Employee Signature block, you are authorizing a change in your records. If you wish to retain a copy of the completed form, please print a copy before submitting it. For questions email HR.

Help When you see this sign, click for Help pages provided for your convenience in locating Help for completion of the Personal Data Form (PDF).

Effective Date: (mm/dd/yyyy)		Check Mail Location#: [4 nos.]		Help:Check Location
Email Address:

UCID:

Last Name:

First Name:

MI:

Suffix:

Help:Suffix

Work Tax Location:

If "Other" Working Tax Location, please provide below:

Employee Work Phone:		Mail Location:
Home Address: Street		City:
State:		Zip:

State Tax Location:

Please select one of the two Tax Code options:

City/School or Residence Tax:

Home Phone:

Unlisted

Yes
No

Help:Emergency Contact

Emergency Contact:

Relationship:

Emergency Phone:

Date of Birth: (mm/dd/yyyy)

Gender:
Male Female

Veteran Status:	Military Status:
Ethnicity:

Resident Status:

Help: Country of Residence

Country of Residency:

Help: Visa Type

Work Permit/Visa Type:

Visa Expires: (mm/yyyy)

Residence Status ID Type:

Education Data

Education Establishment:

Education Level:	Year of Degree: (yyyy)
Degree:	Year of Degree: (yyyy)

Degree Institution/University Name:
Help: University Name/Code

Degree Institution/University Code:

(Four Digits)

Program/Major Code:

Help: Program/Major

Degree:	Year of Degree: (yyyy)
Location First Degree Earned:
(Faculty Only) Instructional Program:	Help: Instructional Program

Authorization
By typing in your name in the Employee Signature field, you are authorizing a change in your records.

I certify the information I have furnished on this form is true, correct and complete to the best of my knowledge. Furthermore, I understand the information I supplied may be audited by the University and/or representatives. I understand that falsifying documents may be grounds for disciplinary action up to and including termination of employment. In addition, I may be in violation of federal and/or state laws and subject to prosecution.

Employee Signature:

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Human Resources
340 University Hall · 51 Goodman Drive · University of Cincinnati
PO Box 210039 · Cincinnati, OH 45221-0039 · 513-556-6381
Send comments or questions to: Human Resources