Transcription of Employee Information
1 US department of LaborEmergency InformationWe need to know who to contact in case of an emergencyInstructions -please print or type the requested Employee Information section-Provide name , address and phone number for two emergency contacts Under Contact the completed form and turn it in to your Complete a new form when any of the Information provided becomes personnel office will keep the original and send a copy to your Information --Organization: Employee name :Work Location orRoom Number:Title andGrade:Home StreetAddress:City, State, ZipCode:Home phone :Work phone :Contact Information1 Relationship toEmployee: name of ContactZip CodeCityStateStreet Address:Work PhoneHome Phone2 Relationship toEmployee: name of ContactCityZip CodeStateStreet Address:Work PhoneHome PhoneDateSignature of EmployeeDL Form 1-65
