Employee Change of Information Form Name * First Name Last Name Birth date * MM DD YYYY Soc. Security Address Address 1 Address 2 City State/Province Zip/Postal Code Country Mobile Phone # (###) ### #### Landline Phone # (###) ### #### Email Marital Status Married Single Divorced Widowed Sex: Male Female Status: Disabled Veteran Citizenship US Citizen Yes No If No, do you have authorization to work in the US? Yes No Please self-identify EEO Code: Asian African American/Black Caucasian/White Hispanic/Latino Native Hawaiian/Pacific Islander American Indian or Alaskan Native Emergency Contact Information Name First Name Last Name Relationship to you Mobile Phone (###) ### #### Home Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Dear ATIL Employee , Thank you for submitting your change of information form. We have received your form.If you have any questions, please don’t hesitate to reach out.Thank you again!