Boston College Personal Data Form

Version 2.1

This form is for new Boston College employees only. If you are already an employee of Boston College, use the UVIEW Agora application or the Personal Data Update Form to modify your personal data.

The following documents must be attached to this form:

Copy of voided check(s) or savings account verification form for account(s) in which payroll amount(s) will be deposited.
Completed Form I-9 (U.S. Employment Eligibility Verification)
For non-US citizens, completed Foreign National Information Form
For members of Religious Order, a letter from Religious Order verifying exemption from federal tax and FICA withholding and providing Direct Deposit Information.

Select a section header to link to online instructions.

I. Employee Data

Last Name		Suffix
First Name	Middle Initial	Prefix

Social Security Number

Birthdate (mm/dd/yyyy)

Gender (Required)
Female Male

State or Country of Birth

Have you ever been employed by Boston College? Yes No
If yes, select what type of position you held
What year did your BC Employment end?

II. Permanent (Legal) Address (for non-US citizens, please use non-US address)

Street Address	Apartment Number
Optional Address Line	Post Office Box Number
City	State	Postal Code
Country	Telephone Number (including country code and area code)

III. Local Address (if different from Permanent Address)

Street Address	Apartment Number
Optional Address Line	Post Office Box Number
City	State	Postal Code
Country	Telephone Number (including area code)

IV. Self-Identification

Federal regulations require that all Boston College employees be identified in accordance with the standards for race and ethnicity classification developed by the U.S. Office of Management and Budget (OMB). To comply with federally mandated affirmative action reporting and analysis, Boston College must collect, report, and analyze accurate information about the Boston College workforce as a whole.

Boston College requests your voluntary assistance in meeting this important requirement by self-identification, the preferred method of employee identification. The information obtained will be kept confidential and is used only in accordance with applicable laws and regulations. For employees who do not self-identify, federal law requires Boston College to determine this information by visual survey. Thus every employee must be identified in accordance with OMB standards, either by self-identification or visual survey. If you have any questions concerning the University's legal obligation to collect and report on this data, please contact The Office for Institutional Diversity.

Marital Status
Single Married

Race or Ethnic Group (Required)

Do you have a disablility?
No Yes

Veteran Status

V. Emergency Contact

Name	Relationship
Telephone Number (including country and area code)

VI. Additional Information

Highest Level of Education

I learned of this job through

Citizenship Status

If non-US citizen, indicate country of citizenship

If you are a member of a Religious Order please indicate:
Boston College Jesuit
Non-Boston College Jesuit or Other Religious Order
Please attach a copy of letter from Order verifying exemption from withholding and confirming Direct Deposit information.

VII. Payroll Direct Deposit Authorization

I authorize Boston College to deposit any payroll amounts owed to me to my account at the depository institution(s) listed below. I authorize Boston College to debit my account only for the purpose of correcting an amount erroneously credited to my account. I understand it is my responsibility to verify that payments issued by Boston College have been credited to my account before attempting to draw on the funds. I understand that this authorization will remain in effect until I change my account number and notify Boston College in writing by completing a Personal Data Update Form.

Complete the information below for bank or credit union. Insert $ or % amount to be deposited in first account; the remainder of net earnings will automatically be deposited in 2nd account. Direct deposit may not become effective for at least one paycheck after this change is processed.

Primary Bank Account:

Type of Account
Checking
Savings

Bank/Credit Union Name

$ of Net Pay

% of Net Pay

All of Net Pay

Secondary Bank Account: (If you did not deposit your entire salary into the account specified above, the remainder of your salary will be deposited into this account.)
Type of Account Checking Savings	Bank/Credit Union Name

VIII. Dependent/Beneficiary Information

(This will not enroll you in any plan nor update any beneficiary information on your benefits records. This is for informational purposes only and is required of all benefits-eligible employees.)

*Student employees and other non-benefits eligible employees should not complete this section.

1.	Name			Social Security Number
	Date of Birth	Address (if different from employee)
	Relationship	Full-time Student? No Yes	Gender Female Male	Marital Status Single Married

2.	Name			Social Security No
	Date of Birth	Address (if different from employee)
	Relationship	Full-time Student? No Yes	Gender Female Male	Marital Status Single Married

3.	Name			Social Security No
	Date of Birth	Address (if different from employee)
	Relationship	Full-time Student? No Yes	Gender Female Male	Marital Status Single Married

4.	Name			Social Security No
	Date of Birth	Address (if different from employee)
	Relationship	Full-time Student? No Yes	Gender Female Male	Marital Status Single Married

5.	Name			Social Security No
	Date of Birth	Address (if different from employee)
	Relationship	Full-time Student? No Yes	Gender Female Male	Marital Status Single Married

IX. Signature

Signature: _____________________________________ Date: ________ Ext.: ________

X. Processing (to be completed by HRSC representative)

EAGLE ID
(First 8 digits on BC Eagle-One Card):

Processed in HRSC by:

_______________________ Date: ________

Important! Please keep a copy for your records.