Post-Employment Personnel Data Form PD-7a

PD-7a	THE UNIVERSITY OF NORTH CAROLINA AT GREENSBORO	DATE PREPARED: April 26, 2024
	POST-EMPLOYMENT PERSONNEL DATA FORM
Please use the Print button at the bottom of the page.

Personal Data
Name	Prefix	First	Middle	Last	Suffix
Social Security Number			Please attach copy of Social Security card to printout.

Permanent
Address

Street

City

State

Zip

Are You:

Hispanic or Latino
Not Hispanic or Latino

Ethnicity

Sex

Female
Male

Date of Birth (MM/DD/YYYY)	Place of Birth	Citizenship
Country of Legal Residence	Visa Type If not US Citizen	Visa Expiration Date
If employee is related by kinship or marriage to a university employee, give name, relationship, and department.
Relative's Name	Relative's Relationship	Relative's Department

Current E-mail Address
The information in this block is for campus directory purposes only. If you do not wish this information to be included, please ignore this section.
Spouse's name	Home phone

Curriculum vitae: If dates and locations of your education and employment records are included on your curriculum vitae, the curriculum vitae may replace the education and employment sections of this form.
Education
Institution	Location	Degree	Major Field	Date Conferred

Employment Record
Beginning Date	Ending Date	Firm or Institution	Title/Position

Professional Activities

Active memberships in learned and professional societies.

If you are a member of Phi Beta Kappa Society:

When were you initiated?

Where were you initiated?

If you were initiated under a different name (such as maiden name) what was it?

Other learned and professional societies.

Awards and honors

Credits in honorary publications (I.E. Who's Who in America, American Academy of Science)

Publications and other creative activities

Research projects carried out or under way

Click the "Print PD-7a" button and return the printout, Curriculum vitae and a copy of your Social Security card to:

The University of North Carolina at Greensboro
Associate Vice Provost for Faculty Personnel Services
201 Mossman Bldg.
1202 Spring Garden St.
Greensboro, NC 27412