CONTRACTOR INFORMATION FORM Please fill-up the form and sign. JOB INFORMATION Contractor Number: Date Hired: VA Position: Department: Salary in $: Schedule: From AMPM TO AMPM TIMEZONE PHEST Personal Information Full Name: Nickname: Address: City: State/Province: Zip Code: Country: Contact Number: Email Address: Birth Date: Marital Status: SingleMarriedSeparatedAnnulledWidow Age: Gender: MaleFemale Nationality: Government ID: Expiration Date: Payroll Information Bank: Branch Address: Account Name: Account Number: Salary: Bi-WeeklyMonthly I hereby certify that, to the best of my knowledge, the provided information is true and accurate. Sign here: [signature* signature class:form-signature cols:500 rows:150]
