O'Neill Public Schools Photo ID Questionnaire
North Central District Health Department will be gathering the following information in order to create new staff ID badges. Please complete the following information; starred fields are required for this system. Other fields are optional, but could be useful if you are injured in an incident at school. Emergency personnel could scan your ID badge for access to the additional information. Be sure to click submit when you are finished.
Person Tab
Last Name
Your answer
First Name
Your answer
Middle Initial
Your answer
Suffix
Your answer
E-Mail Address
Your answer
Driver's License Number
(this is the unique identifier for the ID system)
Your answer
Date of Birth
Your answer
Title
Private Tab
Home Address
Your answer
City
Your answer
Zip Code
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Emergency Contact Person
Your answer
Emergency Contact Phone Number
Your answer
Building Permissions
check all that apply
Required
Medical Tab
Gender
Resting Pulse
Your answer
Blood Type
Your answer
Organ Donor
Your answer
Allergies
Your answer
Hair Color
Your answer
Eye Color
Your answer
Physician's Name
Your answer
Physician's Phone Number
Your answer
Medications
Your answer
Height
Your answer
Weight
Your answer
Submit
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