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