Employment Status. Employee Information Social Security Number Name Prefix Mr. Ms. Mrs. Dr.

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1 Biographical Data Sheet for Employees This form must be completed by the employee. Please refer to Important Information in the upper left corner. This information is used to create your personnel record in accordance with state and federal laws. Employment Status EHRA Faculty EHRA Non Faculty SHRA (Staff) Non-Student Temporary Full-Time or ¾ Time Part-Time As Needed Basis Date Employment Begins (mm/dd/yyyy) Employee Information Social Security Number Name Prefix Mr. Ms. Mrs. Dr. Full Name (as it appears on SS card) Name Suffix Jr. Sr. II III Preferred First Name Home Address Address City State Zip Home Telephone Mobile Telephone List in Campus Directory? Yes No Department Where Employed Campus Telephone Sex Male Female Marital Status: Single Married Other Date of Birth (mm/dd/yyyy) Place of Birth Have you ever retired from any North Carolina State Agency? Yes No Selective Service Status (Required under NC General Statutes 143B-421.1) Do you certify that you are registered with the US Selective Service? Yes No If you answered No, please indicate why you are not registered by checking the appropriate box below: I am female. (Note: Females are not required to register with the Selective Service System) I am in the armed services on active duty (Note: members of the Reserves and National Guard are not considered on active duty) I am under the age of 18 years. I was born before I am a permanent resident of the Trust Territory of the Pacific Islands or the Northern Mariana Islands. I am a non-immigrant alien. Citizenship United States Non-Resident Foreign Alien Resident Foreign Alien Country of Citizenship: Race/Ethnicity Ethnicity: Are you Hispanic or Latino? (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish origin or culture, regardless of race.) Yes No Race: (Select one or more) White: (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) Black or African American: (A person having origins in any of the black racial groups of Africa.) American Indian or Alaska Native: (A person having origins in any of the original peoples of North and South America (including Central America) who maintains tribal affiliation or community attachment.) Asian: (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.) Native Hawaiian or Other Pacific Islander: (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.) Disability (Definitions can be on found the last page) Please check this box if you believe you may be covered by the Rehabilitation Act of 1973, as amended, and/or the Americans Disabilities Act of 1990as amended. Please check this box if you can perform the essential duties of your current job with or without reasonable accommodation. If you are in need of reasonable accommodations to perform essential job duties, please contact the Office of Disability Services at or visit: (Brochure available at the HRS Office) Continue to Other Side

2 Military Experience Please Check any that Apply: Special Disabled Veteran means (i) veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a disability (A) rated at 30 percent or more, or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 3106 of Title 38, U.S.C. to have a serious employment handicap; or (ii) a person who was discharged or released from active duty because of a service-connected disability. Veteran of the Vietnam-era means a person who (i) served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty for a service-connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases. Other Protected Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense. (For the Veterans Administration s listing of the campaigns and expeditions since World War II in which the U.S. has been engaged see Recently Separated Veteran means any veteran during the three-year (one-year for VETS 100) period beginning on the date of such veteran s discharge or release from active duty in the U.S. military, ground, naval or air service. Separation Date / / Armed Forces Service Medal Veteran means any veteran who while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation to which an Armed Forces service medal was awarded pursuant to Executive Order (61 FR 1209). Disabled Veteran means (i) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administrated by the Secretary of Veterans Affairs, or (ii) a person who was discharged or released from active duty because of a service connected disability. In Case of Emergency, Please Notify Person s Name Relationship Home Telephone Mobile Telephone Address City State Medical Alert Information Continue to Next Page

3 Degree (If Applicable) Please begin with your highest degree awarded Degree Major/Area of Degree Year Degree Received University City State Degree Major/Area of Degree Year Degree Received University City State Degree Major/Area of Degree Year Degree Received University City State List any other licenses and certifications (provide dates and sources of issuance): IMPORTANT: To insure that you receive your paycheck on time, please complete this Biographical Data Sheet and Employment Packet in its entirety. If you are an EHRA Faculty or EHRA Non Faculty employee, please return this Biographical Data Sheet with your contract letter. You can pick up your Employment Packet at Human Resource Services or online at For SHRA Employees/Staff, please return the entire employment packet, including the Biographical Data Sheet to Human Resource Services. You can pick up an Employment Packet at Human Resource Services or online at For all New Employees, please present this completed packet, along with appropriate, current identifications (such as drivers license and Social Security Card or an unexpired passport) to Human Resource Services, Founders Hall, for I-9 verification. If you do not have the aforementioned documents, please refer to the form I-9 for a complete list of accepted documents. For automatic deposit to be made to your checking account, please furnish a voided check (NOTE: Automatic Deposit is required for all permanent employees). NOTE: Disclosure of your Social Security Number is mandatory. ASU is authorized to obtain this information pursuant to 26 United State Code, sections 3402 and 6109, and 42 United State Code, section 405. The number will be used as a personal identifier for records necessary to administration of and compliance with federal tax laws and regulations, and motor vehicle registration regulations. Important Definitions: The Americans with Disabilities Act of 1990 requires employers to provide qualified individuals with disabilities an equal opportunity to benefit from the full range of employment-related opportunities available to others. The Rehabilitation Act of 1973 provides that no qualified individual with a disability shall be excluded from, denied the benefits of, or be subjected to discrimination under any program or activity that receives federal assistance. Reasonable Accommodations provide employment opportunities for persons with disabilities who otherwise would not be able to perform the essential functions of their job, and allow employees with disabilities to perform or be more productive. Veteran means a person who served in the Armed Forces of the United States on active duty, for reasons other than training, and has been discharged under other than dishonorable condition. Signature Date (Revised 11/2015)

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10 Automatic Deposit Form Federal Advisory for International ACH (Automated Clearing House) Transactions: Employees who forward the entire amount of their ASU pay to a bank in another country (after having it direct deposited by ASU into a US bank) must notify Payroll at (828) , per the Office of Foreign Assets Control (OFAC) of the US Treasury Department. I acknowledge that electronic payments to the designated account must comply with the provisions of U.S. law, as well as the requirements of the Office of Foreign Assets Control (OFAC). You must check one of the following: I affirm that the entire amount of any direct deposit payments made by Appalachian State University to the financial institution and account that I have designated: are not subject to being transferred to a foreign bank account. I affirm that the entire amount of any direct deposit payments made by Appalachian State University to the financial institution and account that I have designated: are subject to being transferred to a foreign bank account. I also understand that the University may elect to remit future payments to me via paper check instead of electronically. All ASU employees are required to have their payroll check deposited to the bank or financial institution of their choice within the United States. Automatic deposit may be made to the employee s checking, savings, or money market account. For automatic deposit to be made to your checking account, complete this form, attach a blank check, and write the word VOID across it. For direct deposit to be made to your savings or money market account, complete the form and furnish both your bank routing number and your account number. If an employee terminates employment with ASU but resumes employment at a future date, it will be necessary to sign up once again for automatic deposit by completing a new automatic deposit form and submitting it to the Office of Human Resources if a staff or faculty employee or Student Employment if a student employee. Employee Name: Home Mailing Address: Name of Bank: Type of Account: (Check One): NOTE - Attach VOIDED check or bank document displaying account and routing numbers Checking Account #: Routing #: Savings Account #: Routing #: Money Market Account #: Routing #: I hereby authorize Appalachian State University to deposit my payroll check with the bank indicated above. (If you change back accounts from that indicated above, you will be required to immediately fill out this form with your new account information. Waiting period(s) outlined above will again apply.) Signature Social Security Number Department Date

11 BOONE, NORTH CAROLINA The Office of Human Resources 330 University Hall Dr. Phone (828) Fax (828) Overtime Agreement I understand that it is the policy of the State of North Carolina to give employees subject to the Fair Labor Standards Act overtime compensation in the form of compensatory time off, rather than in monetary compensation, whenever possible. I understand that the decision to give either compensatory time off or monetary compensation is a decision to be made by management, and is not my choice. I understand that acceptance of these policies is a condition of my employment with Appalachian State University. Employee Signature Print Name Date A MEMBER INSTITUTION OF THE UNIVERSITY OF NORTH CAROLINA - AN EQUAL OPPORTUNITY EMPLOYER

12 Equal Employment Opportunity Policy Appalachian State University is committed to providing equal opportunity in education and employment to all applicants, students, and employees. The university does not discriminate in access to its educational programs and activities, or with respect to hiring or the terms and conditions of employment, on the basis of race, color, national origin, religion, creed, sex, gender identity and expression, political affiliation, age, disability, veteran status, or sexual orientation. The university actively promotes diversity among students and employees. Effective 7/21/08 Probationary/Career Status All state employees subject to the State Human Resources Act (SHRA) who are appointed to fulltime, part-time, or time-limited permanent positions must serve a probationary period. The probationary period is an extension of the selection process and allows time for the effective evaluation and adjustment for the new employee. The length of an employee s probationary period and the period of time to achieve Career Status is 12 months from the date of hire with continuous employment in a permanent position. Law Enforcement Only: If the law enforcement officer has completed the required training (BLET) before the employee is hired, that employee is subject to a 12-month probationary period; otherwise, the employee must complete a 24-month probationary period. A probationary employee may be discharged at any time during the probationary period, if the probationary employee s supervisor determines the employee s performance does not meet departmental expectations. A probationary employee does not have any grievance rights under North Carolina State policy. I have read and understand the above statements. Date Employee Signature Revised 11/2015

13 Voluntary Self-Identification of Disability Form CC-305 OMB Control Number Expires 1/31/2017 Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive compulsive disorder Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchair Diabetes Schizophrenia Missing limbs or Intellectual disability (previously called mental Epilepsy Muscular partially missing limbs retardation) dystrophy Disabilities include, but are not limited to: Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON T HAVE A DISABILITY I DON T WISH TO ANSWER Your Name Today s Date

14 Voluntary Self-Identification of Disability Reasonable Accommodation Notice Form CC-305 OMB Control Number Expires: 1/31/2017 Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor s Office of Federal Contract Compliance Programs (OFCCP) website at PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

15 Post-offer Invitation to Self-Identify Veteran Status 1. Appalachian State University is a Government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows: A disabled veteran is one of the following: o a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or o a person who was discharged or released from active duty because of a service-connected disability. A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran s discharge or release from active duty in the U.S. military, ground, naval, or air service. An active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An Armed Forces service medal veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order Protected veterans may have additional rights under USERRA the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor s Veterans Employment and Training Service (VETS), tollfree, at USA-DOL. 2. As a Government contractor subject to VEVRAA, we are required to submit a report to the United States Department of Labor each year identifying the number of our employees belonging to each specified protected veteran category. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. I BELONG TO THE FOLLOWING CLASSIFICATIONS OF PROTECTED VETERANS (CHOOSE ALL THAT APPLY): [ ] DISABLED VETERAN [ ] RECENTLY SEPARATED VETERAN [ ] ACTIVE WARTIME OR CAMPAIGN BADGE VETERAN [ ] ARMED FORCES SERVICE MEDAL VETERAN [ ] I am a protected veteran, but I choose not to self-identify the classifications to which I belong. [ ] I am NOT a protected veteran. If you are a disabled veteran it would assist us if you tell us whether there are accommodations we could make that would enable you to perform the essential functions of the job, including special equipment, changes in the physical layout of the job, changes in the way the job is customarily performed, provision of personal assistance services or other accommodations. This information will assist us in making reasonable accommodations for your disability. 3. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended. 4. The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed. 5. Appalachian State University is committed to equality of education opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, national origin, religion, sex, gender identify and expression, veteran status, political affiliation, age, disability, genetic information or sexual orientation. Appalachian also actively promotes diversity among students and employees. Appalachian State University is an Affirmative Action/Equal Opportunity Employer. For more information about the University s Affirmative Action Program and policies, please visit the Affirmative Action Website.

16 Appalachian State University AppCard (Photo ID) Request and Parking Permit Request Form This form must be presented to the AppCard Office, lower level, Trivette Hall, for card to be made. Trivette Hall is located on Rivers Street behind the duck pond. This Form must ALSO be presented to the Parking and Traffic Department located in the River Street Parking Deck for your parking permit. Employee Name: Banner ID: Department: Staff Faculty Graduate Assistant Permanent Temporary Retired Full-Time Part-Time The Appalachian Identification Card (AppCard) will entitle bearer to use certain University facilities, equipment, and materials. Damages to University facilities and/or equipment and/or assessments for equipment and/or materials which are not returned (or which are returned with a delinquent status) will be charged to above-named employee s account through the Controller s Office. There is no charge for your initial AppCard. However, there is a $15.00 fee to replace each lost, stolen, or damaged card. I understand and agree to these conditions. Employee s Signature Date Detach and retain for your information. Your AppCard can be useful to you in a variety of ways. Some of these are: Use of materials through University Libraries. Access to Faculty/Staff parking lots with slide readers. An Appalachian Express Account is available to permanent faculty and staff only. Permanent faculty and staff may sign up for this service through the AppCard Office located in Trivette Hall. Your Express Account allows the use of your AppCard to pay for services and merchandise in all Appalachian Food Services Units, the University Bookstore, the Market, and all vending machines. Charges made on your Express Account are deducted monthly from your paycheck. Access to Quinn and Mt. Mitchell Fitness Centers is offered to permanent faculty and staff receiving benefits, through monthly payroll deduction ($4.00 individual membership or $8.00 family membership.) Each family member/dependent must have an AppCard ($7.00 per card) in order to use the recreational facilities. Temporary employees must pay direct at the AppCard Office for facility use at a rate of $20.00 per semester. Family/dependent facility use is not available for temporary employees. You may contact University Recreation at for further information on these facilities, their hours of operation, etc. Reminder: There is a $15.00 fee to replace a lost, stolen, or damaged AppCard. Guard it closely!