F00013 Registration/Emergency Contact for Special Assignment Appointments

Instructions:

Welcome to the World Bank Group HR Forms Instructions page.

This form filler tool is designed to assist you in electronically entering your data and printing a paper form with a unique barcode corresponding to your entered data. Once you've completed your answers and printed the form, you'll need to submit it either by email or in person, depending on the form type.  Please note that the data you enter is directly captured in the form's unique barcode, so it's important that you do not make any handwritten changes, corrections, or additions to the data or to the form after it has been printed. Doing so may result in data errors and processing delays.

In case you notice any errors after printing your form, or if you've left a field blank, we recommend starting over and completing a new form. It's also important to remember that your information is not saved by the form filler and can no longer be accessed after you print it. Therefore, please be extra careful in reviewing your answers, as it is impossible to make any corrections after the form is printed.

Each form will take approximately ten minutes to complete. Please ensure you have the needed documents such as passport to extract information that may be required in some fields. Do not close the forms until they are ready for a download. Partially filled forms cannot be saved to be completed later. If you need further assistance, please contact. Thank you!

Information on Completing the Form

IMPORTANT: The following documents are required for yourself and each dependent:

a) For non-U.S. individuals: copies of photo and bio pages of passport, U.S. visa (such as G4) or Green Card, & I-94 card (front & back);

b) Copy of valid Employment Authorization card if you will start employment with an F1, J1, L2 or A1/A2 dependent visa.

c) Copies of birth certificates for yourself and any listed dependents;

d) Adoption papers for legal adoptions;

e) Copies of certificate / proof of marriage. Domestic partnerships must be approved by the HR Operations in accordance with the domestic Partner policy.  A separate package for registering your Domestic partnership will be provided.

Please return this form to the HR Operations via (Please select one transmittal format, and submit only once):

1. Email at hroperations@worldbank.org

2. Fax (202) 522-7026

3. Interoffice mail, MSN G2-202

Need Help? 

If you are experiencing any issues, please contact HR Operations via email: hroperations@worldbank.org  or phone 202-473-2222 or 5220+32222

Revision 25 Apr 2023

Staff Information

World Bank Group UPI*

Staff Member's Name*

Entry on Duty Date*

Date of Birth*

SSN

City of Birth*

Country of Birth*

Nationality (Indicate if multiple)*

Marital Status*

If non-US, current US Visa & Alien Registration number (if applicable) - provide copy

Spouse/Domestic Partner Information

Spouse/Domestic Partner Name*

Relation*

Date of Birth*

SSN

Gender*

City of Birth*

Country of Birth*

Nationality (Indicate if multiple)*

If non-US, current US Visa & Alien Registration number (if applicable) - provide copy

Children Information

Child is:*

Name(Last, First, Middle)*

Gender*

Date of Birth*

City of Birth*

Country of Birth*

Nationality (Indicate if multiple)*

SSN

If non-US, current US Visa & Alien Registration number (if applicable) - provide copy

Address Information

MANDATORY - Home Mailing Address in new Duty Station. Please fill out even if a temporary address.  Enrollment into the Medical Insurance Plan may be delayed without a local mailing address at the new duty station.

Street*

Address*

Home phone*

Cell phone*

Emergency Contact

Name*

Relation*

Street*

City*

Country*

Phone*

Certification and Signature

I, the undersigned, certify that the information provided by me is complete and true.  I understand that World Bank Group benefits are subject to audit, and I consent to and authorize the release of any information needed for benefits administration to the World Bank Group or their representatives.  I understand any misstatements regarding the use of benefits may result in disciplinary measures per Staff Rule 3.00 or 8.01.

I understand that in the event of a conflict between  this form and the Staff Rules, the Staff  rules will  prevail.

Staff Member's Signature

Date

After filling this document, you must sign and date it before returning this document to the World Bank Group. Please ensure ALL information in the submission form is complete and accurate before printing the form. This will generate your form(s) as a PDF file. Review the file for accuracy and completeness. If there is an error, please start a new form.