Emergency Contacts

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Emergency Contacts

Please use this form to submit emergency contacts or any change in your emergency contact information. (This does not update the Everbridge emergency contact system. This is for HR's use to contact someone on your behalf in the case of an emergency). If you do not know your APU ID, please enter 000000000 (9 zeros) for your ID.

APU ID # *

Must be 9 digits (including leading zeros)

Employee Name *

Your legal name or your Name as it appears on your paycheck

Your emergency contact name: *

The name of the person we contact in the event of an emergency?

Primary Contact? *

Let us know if this is your primary emergency contact.

Yes

Relationship to this contact *

Identify your relationship with this contact

Does this contact share your same phone number? *

If "No" then please enter their phone number below

Yes

Your emergency contact's phone

Format: ###-###-####

Secondary number for your emergency contact

Format: ###-###-####

Does this emergency contact share your same address? *

If "No" then please enter their address below

Yes

Address Line 1

Address Line 2

Address Line 3

City

State

For example: "CA"

Zip

Submit

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