Employee Census Form
Company Name
*
Name
*
Company Contact
Phone
*
Online Employee Census
Download our
Excel Employee Census Template
if you have
> 10 employees or prefer Excel format.
Full Name
DOB
Gender
Status
Zip
Network
1
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
2
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
3
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
4
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
5
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
6
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
7
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
8
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
9
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
10
F
M
Employee
Spouse
Dependent
Sharp
Scripps
UCSD
Kaiser
Out Of State
Other
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