Kansas Department of Administration

Employee Data Sheet - Part A

* Indicates a required field
Requestor Information
General Information
Personal Information - Biographical Details
SOCIAL SECURITY NUMBER - DO NOT submit the SS# through e-mail.  Please contact your HR Consultant if the SS# is required for a data change.
Personal Information - Contact Information
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Personal Information - Regional
Eligible to work in US?:
Job Data - Work Location
Job Data - Payroll
Job Data - Salary Plan
Job Data - Compensation
Job Data - Kansas Information
Employment Status:
Benefit Program Participation
Kansas Employment

Length of Service Adjustments

Time Reporter Data
Time Reporter Status:
Time Reporter Type:
 (Interface Agencies Only)

Please remember to fill out the EMPLID, DEPTID and Name at the top of this form

Consent Confirmation:
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