Employee Biographical Data Form

The following form includes basic biographical and demographic data that AvaCon is required to keep on file for tax, legal, and governmental reporting purposes.  AvaCon takes your privacy seriously and all sensitive information will be kept confidential and not disclosed to others except when necessary during the course of business or when required by law.

For the purposes of legal documents and tax reporting, we need to know your legal name.
For the purposes of legal documents and tax reporting, we need to know your legal name. Please enter your full legal first name.
If you have a middle name, enter your middle initial.
Please enter your date of birth in the format MM/DD/YYYY
Enter your US Social Security Number. If you do not have an SSN, skip this question.
Enter the home address of your primary place of residence.
Enter your home phone number in the format (555) 555-5555. If you live outside of the United States, please include your country code. Example: +1 (555) 555-5555
Enter your cell phone number in the format (555) 555-5555. If you live outside of the United States, please include your country code. Example: +1 (555) 555-5555
Enter your work phone number in the format (555) 555-5555. If you live outside of the United States, please include your country code. Example: +1 (555) 555-5555
List any degrees, certifications, or other professional licenses you may hold. Include the degree or certification, topic or area of specialty, the issuing institution, and year completed. Example: BA in Liberal Arts, University of Illinois, 2002.

Equal Opportunity Employment Reporting

AvaCon is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, AvaCon invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Professional Biography & Photo

From time to time, AvaCon may need to publish or provide information about our staff, for example on the company website. Please provide a professional biography of NO MORE THAN 2 to 3 sentences and a photograph. The photograph should be as high resolution as possible, and should be a well-lit headshot that primarily shows your face. Please, no icons, avatars, or graphics!
Please provide a short professional bio highlighting your professional accomplishments. Your bio should be NO MORE THAN 2 to 3 sentences long.
Please upload a high resolution professional photo.