EmployeeInformation

IFD Employee Information 2023

* Indicates required field

Name *

First

Last

Address *

City, State, Zip *

Primary Phone Number *

Type *

Home Cell

Secondary Phone Number *

Type *

Home Cell

Email *

Name *

First

Last

Email *

Primary Phone Number *

Type *

Home Cell Work

Secondary Phone Number *

Type *

Home Cell Work

Relationship to Employee *

Parent/Stepparent Sibling Friend Legal Spouse Grandparent Significant Other Other

If "Other" is marked above, what is the relationship between emergency contact and employee? *

Submit

313 N Hastings Pl
Eau Claire, WI 54703
800-873-0131
715-834-6513