USD 377 Staff Information Form
First Name
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Last Name
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Position with District
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Personal Information
Street Address
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City
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State
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Zip Code
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Home Phone
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Cell Phone
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Personal email address
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Date of Birth
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Last 4 of SSN
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Spouse Name
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Spouse phone number
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Emergency/Medical Information
Primary Doctor
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Physician Phone
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Emergency Contact #1
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Phone number
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Emergency Contact #2
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Phone number
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Allergies
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Any other information/condition that we should be aware of
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Substitute Information
(Only district substitute teachers need to complete this section)
Sub Certification
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Sub Cert Expiration
Your answer
Sub Preferences
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