Contract Employee Account Request

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Please complete the information requested below. We will need this information to create a State UID and to confirm you are not already in both the State system or NCSIS system.

Legal First Name *

Legal Middle Name *

Legal Last Name *

Previous Last Name
(Any previous legal last name, ex. maiden name)

Gender Assigned at Birth *

Date of Birth *

YYYY

Ethnicity *

Home Mailing Address *

City *

Phone Number (Area Code) 000-0000 *

Have you ever been employed in a NC Public School? *

Yes

Required

Active Alternate Email *

Which schools have you been assigned? *

Baton Elem

Caldwell Applied Sciences

Caldwell Early College

Caldwell Online

Collettsville Elem

Davenport A+

Dudley Shoals Elem

Gamewell Elem

Gamewell Middle

Gateway

Granite Falls Elem

Granite Falls Middle

Happy Valley Elem

Hibriten High

Horizons

Hudson Elem

Hudson Middle

Kings Creek Elem

Lower Creek Elem

Sawmills Elem

South Caldwell High

Valmead Elem

West Caldwell High

Whitnel Elem

William Lenoir Middle

Education Center/District Office

Other:

Required

Which of the following accounts need to be created? *

Computer Login

Infinite Campus

Required

Who is requesting this account? Name- Department *

Choose position *

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