Department of Human Resources NEW STUDENT EMPLOYEE - PERSONAL INFORMATION (Please complete fully and accurately) Are you presently employed at the University of Windsor? Employee # □Yes □No Have you ever been employed at the University of Windsor? □Yes □No Are you a University of Windsor Student? □Yes □No Social Insurance Number Student # Marital Status Male Female □Mr □Miss □Mrs □Ms □ □ First Name Middle Last Former Name Date of Birth (YY/MM/DD) Health Ins # Email address Choose one: Canadian Citizen □ Landed Immigrant Country □ Study permit Country □ Working Visa Country □ PERMANENT ADDRESS AND PHONE NUMBER Number, Street Name, Apartment # City, Province, Country Postal Code (Area Code) Phone Number TEMPORARY ADDRESS AND PHONE NUMBER Number, Street Name, Apartment # City, Province, Country Postal Code (Area Code) Phone Number EMPLOYED BY (name of UNIVERSITY DEPARTMENT that hired you) Department Name Effective Complete this question only if different from University Dept that hired you University Department to Forward Pay Statement/Correspondence PLEASE INDICATE ALL THAT CURRENTLY APPLY: Must be completed for processing Undergraduate Teaching Assistant Graduate Teaching Assistant □ □ Proctor Work Study □ □ Research Assistant Wise Program □ □ Co-op position Outstanding Scholar □ □ Casual □ EMERGENCY CONTACT PERSON Name Relationship (Area Code) Phone Number City/Province/Country NOTE: YOU MUST HAVE A BANK ACCOUNT IN ORDER TO BE PAID BY THE UNIVERSITY. PLEASE COMPLETE “AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS FORM”. Student Signature Date
Department of Human Resources NEW STUDENT EMPLOYEE - PERSONAL INFORMATION (Please complete fully and accurately) Are you presently employed at the University of Windsor? □Yes □No Employee # Have you ever been employed at the University of Windsor? □Yes □No Are you a University of Windsor Student? □Yes □No Social Insurance Number Student # □Mr □Miss □Mrs □Ms Marital Status □ Male □ Female First Name Middle Last Former Name Date of Birth (YY/MM/DD) Health Ins # Email address Choose one: Canadian Citizen □ Landed Immigrant □ Country Study permit □ Country Working Visa □ Country PERMANENT ADDRESS AND PHONE NUMBER Number, Street Name, Apartment # City, Province, Country Postal Code (Area Code) Phone Number TEMPORARY ADDRESS AND PHONE NUMBER Number, Street Name, Apartment # City, Province, Country Postal Code (Area Code) Phone Number EMPLOYED BY (name of UNIVERSITY DEPARTMENT that hired you) Department Name Effective Complete this question only if different from University Dept that hired you University Department to Forward Pay Statement/Correspondence PLEASE INDICATE ALL THAT CURRENTLY APPLY: Must be completed for processing □ Undergraduate Teaching Assistant □ Graduate Teaching Assistant □ Proctor □ Work Study □ Research Assistant □ Wise Program □ Co-op position □ Outstanding Scholar □ Casual EMERGENCY CONTACT PERSON Name Relationship (Area Code) Phone Number City/Province/Country NOTE: YOU MUST HAVE A BANK ACCOUNT IN ORDER TO BE PAID BY THE UNIVERSITY. PLEASE COMPLETE “AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS FORM”. Student Signature Date
Student%20Employee.docx