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.
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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.
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
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
Address Line 1
Address Line 2
Address Line 3
City
State
For example: "CA"
Zip
Submit
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