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Enter the following fields as required:
INDIVIDUAL SSN (Key)
USER AGENCY (Required)
- Enter the three-digit agency number.
NAME – FIRST, MIDDLE, LAST (Required)
-
Enter the employee’s full name. Do not use punctuation marks. However, hyphens are acceptable.
-
Note: If the name has a suffix, put it in the LAST NAME field preceded by a space. For example, John C Smith Jr or William E Harris III (no periods, commas, or special characters).
FAMILIAR NAME (Optional)
- The name by which the individual wishes to be known.
ADDRESS LINE 1 (Required)
PROTECT IND (Optional)
-
Blank field |
Protection not required by law |
01 |
Protection based by law for any reason other than 02, 03, 04 or 05 |
02 |
Current or former CPO (Certified Peace Officer) |
03 |
Current or former protected agency employee |
04 |
Both a CPO and protected agency employee |
05 |
Agencies with protected divisions |
Note: If an option other than blank is entered, the employee's address, home phone, SSN, family information and emergency contact information is protected and will not be released to the public.
ADDRESS LINE 2 (Optional)
CITY (Required)
STATE (Required)
- Enter the post office abbreviation for the state where the individual resides. This field defaults to TX.
ZIP CODE (Required)
- Enter the five-digit ZIP code (hyphen and four additional digits optional).
COUNTY (Optional)
- If the county code is unknown, leave this field blank. The system updates automatically when you press Enter to process the transaction.
COUNTRY (Optional)
- Defaults to USA.
HOME PHONE (Optional)
WORK PHONE (Optional)
EXT (Optional)
SEX (Required)
-
RACE (Required)
-
0 |
White |
1 |
Black |
2 |
Hispanic |
3 |
Asian |
4 |
American Indian or Alaskan Native (AIOAN) |
5 |
Other (Higher Education Agency Use Only) |
6 |
Native Hawaiian or Other Pacific Islander (NHOPI) |
7 |
Two or more races (MULTI) |
BIRTH DATE (Required)
- Enter the individual’s birth date. This information is required for insurance purposes (MM/DD/YYYY).
EDUCATION LEVE (Optional)
-
Blank field |
Not defined |
A |
Doctorate |
B |
Postdoctorate |
C |
Bachelor’s – voc rehab |
D |
Master’s – voc rehab |
E |
Bachelor’s – social work |
F |
Master’s – social work |
G |
Doctorate – social work |
0 |
Less than high school |
1 |
High school or equivalent |
2 |
Some college |
3 |
Two-year college degree |
4 |
Four-year degree (unrelated to business) |
5 |
Four-year degree (related to business) |
6 |
Some postgraduate work |
7 |
Postgraduate degree (unrelated to business) |
8 |
Postgraduate degree (related to business) |
9 |
Master’s |
RELEASE DATA SECTION
-
Enter a value indicating whether the individual allows the agency to release any of the following information to the public. A value of Y (yes) or N (no) will be used to determine whether the employee's address, home phone, Social Security number, family information and emergency contact can be released under the Open Records Act.
- Address (Required)
- Home Phone (Required)
- SSN (Required)
- Family Info (Required)
- Emer Contact (Required)
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