New Employee Personal Info Please fill out the following information completely. All of this information is required to complete your benefit enrollment. If you have questions, please contact your Human Resources representative. Employee ID Warning: Employee ID should not match SSN SSN First Name Middle Initial Last Name Date of Birth Gender MaleFemaleOther Contact Info Please enter your complete contact information. Press Submit when you are ready to log onto the enrollment system. Be sure and keep your PIN in a safe place. This is your "secret code" for accessing the system, and is the equivalent of your digital signature. Address USA Canada Mexico Afghanistan Akrotiri Albania Algeria American Samoa Andorra Angola, Republic of Anguilla Antarctica Antigua/Barbuda Argentina Armenia Aruba Ascension Islands Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Islands Clipperton Islands Cocoa Islands Cocos Islands Colombia Comoros Federal And Islamic Republic Of Congo (Brazzaville) Congo (Kinshasa) Cook Islands Coral Sea Islands Costa Rica Cote D'Ivorie Croatia Cuba Curacao Cyprus Czech Republic Czechloslovakia Denmark Dhekelia Diego Garcia Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia, Republic of Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Island Holy See (Vatican) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique (French Antilles) Mauritania Mauritius Mayotte Micronesia (Federated States of) Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands (the) Netherlands Antilles New Caledonia NewZealand Nicaragua Niger (the) Nigeria Niue Norfolk Island North Korea (Democratic People's Republic of) North Macedonia Northern Mariana Islands (the) Norway Oman Pakistan Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcarin Islands Poland Portugal Puerto Rico Qatar Reunion Island Romania Russia Rwanda Saint Barthélemy Saint Martin (French part) Saipan Samoa San Marino Sao Tome Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea (Republic of) South Sudan Spain Sri Lanka St Helena St Pierre and Miguelon St. Kitts/Nevis St. Lucia St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Island Sweden Switzerland Syrian Arab Republic (the) Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Islands Trinidad and Tobago Tunisia Turkey Turkmenistan Turks/Caicos Islands Tuvalu Uganda UK Ukraine United Arab Emirates United States Minor Outlying Islands (the) Uruguay Uzbekistan Vanuatu Republic Of Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Western Samoa Yemen Yugoslavia Zambia Zimbabwe CountryStreet Address Line 1Street Address Line 2City AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GB GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY StateZIP Home Phone EMail Employment If you have been assigned a unique employee identifier by your employer, please enter it at the left. Otherwise, enter your Social Security Number. Then enter your date of hire, location, department, job title, and other employment information in the space provided. Date of Hire Location Select one Alto Park Elementary School Armuchee Elementary School Armuchee High School Armuchee Middle School Armuchee Primary School CAVE SPRING ELEMENTARY SCHOOL CENTRAL OFFICE Coosa High School Coosa Middle School FACILITIES DEPARTMENT FCS College & Career Academy Floyd County Board of Education Floyd Virtual Academy Garden Lakes Elementary School Headquarters Johnson Elementary School Model Elementary School Model High School Model Middle School Pepperell Elementary School Pepperell High School Pepperell Middle School Pepperell Primary School TRANSITIONAL ACADEMY TRANSPORTATION DEPARTMENT Title Annual Salary Hours worked per week Assign PIN Finally, enter a Personal Identification Number (PIN). The PIN is your secret code for accessing the system and for signing enrollment forms. You may use any combination of at least 4 letters and numbers. A computer-generated verification code is displayed at the left. Please re-type the Verification Code in the space provided. This step helps prevent malicious use of the site. New PIN Re-type PIN Password Hint Question What city were you born in? What is your favorite book? Who is your favorite author? What is your first pet's name? What is your mother's maiden name? Who is your favorite cartoon character? What is the make of your first automobile? What is the name of an elementary school you attended? Password Hint Answer Verification Code Re-type Verification Code: Submit Reset