Marine IRF

General Information

First name:		Last name:
Middle name:		Title:
*Employee ID:		*Department:	- Choose One - 22 - R/V Atlantis 27 - R/V Knorr
SSN:		Birth date:
Citizen:	Yes No	Gender:	Male Female
If not, which country:		VISA:
EEO Designation:	- Choose One - Hispanic or Latino Female Hispanic or Latino Male White Female White Male Black or African-Amer Female(Not Hispanic or Latino) Black or African-Amer Male(Not Hispanic or Latino) Native Hawaiian or Other Pac Isl Female(Not Hispanic or Latino) Native Hawaiian or Other Pac Isl Male(Not Hispanic or Latino) Asian Female (Not Hispanic or Latino) Asian Male(Not Hispanic or Latino) American Indian or Alska Native Female(Not Hispanic or Latino) American Indian or Alska Native Male(Not Hispanic or Latino) Two or More Races Female Two or More Races Male
Veteran:	N/A Vietnam Veteran Vietnam Disabled Vet Veteran Disabled Veteran Badges/Medals	Disabled:	N/A Hearing Impaired Sight Impaired Speech Disability Ambulatory Disability Mental Disabililty

Action

*Action:	N/A New Hire Re-Hire Step Change Termination Made Regular
Effective Date:		Expiration Date:
Termination Date:		Reason:	N/A Voluntary Resignation Retired Involuntary Resignation End Appointment/Assign Deceased Laid Off 0 Hrs Worked/Calendar Yr

Employment Information

Employment:	Regular Temporary	Bi-Tech Type:	- Choose One - Casual Regular FT Temporary FT
Position:	Master Chief Mate 2nd Mate 3rd Mate CommElectTech Bosun AB OS Corpsman Chief Engineer 1st AE 2nd AE 3rd AE Jr Eng Marine Elect Mar Elect Eng Oiler Wiper Steward Cook Mess Attn Marine Cadet	Step:	- Choose One - Step 1 Step 2 Step 2.5
Salary:

Taxes

Federal:	N/A Exempt Head of Household Married Single Married File Single	# Allowances:
State:	N/A Exempt Head of Household Married Single Married File Single	# Allowances:

Office Information

Office Address:		MS#:
Ext.:		Supervisor:

Education

Degree:	Type:	Major:	Institution:	Date:
N/A PhD Masters Bachelors Associates Diploma	N/A Science Arts Juris
N/A PhD Masters Bachelors Associates Diploma	N/A Science Arts Juris

Home Information

Primary Address:		Public:	Yes No
Home Phone:		Other Phone:

In Case of Emergency Notify

Name:		Relationship:
Address:		Phone:

I-9 Information

LIST A:	- Choose One - 1. US Passport 2. Permanent Resident Card 3. Unexpired Foreign Passport 4. Unexpired Employment Authorization 5. Unexpired Foreign Passport	Expiration Date:	OR
LIST B:	- Choose One - 1. Drivers License 2. ID Card w/Photo 3. School ID w/Photo 4. Voter's Registration Card 5. US Military Card 6. Military Dependent's ID 7. US Coast Guard Card 8. Native American Tribal Doc 9. Canadian Driver's License 10. School Record/Report Card 11. Clinic, Doctor or Hosp Record 12. Day-care/Nursery School Record	Expiration Date:	AND
LIST C:	- Choose One - 1. US SS Card 2. Cert of Birth Abroad 3. Original/Cert Birth Cert 4. Native American Tribal Doc 5. US Citizen ID Card 6. ID Card/Resident Citizen 7. Unexpired Employment Auth	Expiration Date:

Additional Comments

Comments:
*Submitted by:	Mike Brennan Beth Ryan