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Employee Personal Profile

This document contains personal identifying information and emergency contact details for an employee. It includes their name, birthdate, physical description, family details, emergency contacts, relatives, household members, vehicles, medical information, and authorization to release medical information in an emergency. The information is confidential and only to be accessed in an actual emergency situation.

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George Rizk
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94 views3 pages

Employee Personal Profile

This document contains personal identifying information and emergency contact details for an employee. It includes their name, birthdate, physical description, family details, emergency contacts, relatives, household members, vehicles, medical information, and authorization to release medical information in an emergency. The information is confidential and only to be accessed in an actual emergency situation.

Uploaded by

George Rizk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 3

EMPLOYEE PERSONAL PROFILE

The information requested in this questionnaire is voluntary and confidential and is not to be used for any purpose
other than an actual emergency. The contents of this questionnaire shall be kept in a sealed envelope in a secure
area and this envelope shall not be opened except in the case of an actual emergency by the HR & the GM of the
Company. The contents of this questionnaire and a photograph should be updated annually during the employee's
performance evaluation.

PERSONAL IDENTIFYING INFORMATION:

Employee:
Nicknames or other names used:
Employment classification:
Employment location:
Permanent residence:
Phone:
Secondary residence:
Phone:
Other employment, if applicable:
Date of birth: / / Place of birth:
Name of hospital: Mother’s name:
Race: Sex: Complexion:
Height: Weight: Hair color: Eye color:
Scars/marks/tattoos:
Hobbies:
____________________________________________________________________________
Are your fingerprints on file with the company?
Is a current photograph on file with the company?

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FAMILY AND EMERGENCY NOTIFICATION INFORMATION:

Marital status: Anniversary date:


Name of spouse/roommate: Nickname:
Number of children: Children’s names are:
Birthdate:
Birthdate:
Birthdate:
Birthdate:

PERSONS TO CONTACT IN CASE OF EMERGENCY:

Name: Phone:
Address: Relationship:
Name: Phone:
Address: Relationship:
Name: Phone:
Address: Relationship:

IMMEDIATE CLOSE RELATIVES:

Name: Phone:
Address: Relationship:
Name: Phone:
Address: Relationship:
Name: Phone:
Address: Relationship:

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OTHER PERSONS LIVING OR WORKING IN HOUSEHOLD:

Name: Phone:
Address: Relationship:
Name: Phone:
Address: Relationship:

MOTOR VEHICLES USED BY FAMILY:

Year: Make: Model: Color:


License: Driven by:
Year: Make: Model: Color:
License: Driven by:

MEDICAL INFORMATION:

Blood type: Allergic to:


Medical condition requiring treatment or medication:

Medication required: Dosage:


Personal physician: Phone:
Address:

AUTHORIZATION FOR THIS PHYSICIAN TO RELEASE CONFIDENTIAL


INFORMATION IN THE EVENT OF AN EMERGENCY SITUATION REQUIRING
TREATMENT:

Signature: Date:

Page 3 of 3

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