USD 377 Staff Information Form
First Name
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Last Name
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Title
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Personal Information
Home Address
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City
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State
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Zip
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Contact Phone
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Email
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Date of birth
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Last 4 digits of SSN
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Spouse
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Spouse Contact Phone
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Emergency/Medical Information
Physician Name
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Physician Phone
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Emergency Contact (1)
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Emergency Contact (1) Phone
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Emergency Contact (2)
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Emergency Contact (2) Phone
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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
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Sub Preferences
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