Harbor Compliance - Sensitive Information Form

Individual Sensitive Information Form
Employee Instructions

Log in to this JotForm, then go to Publish > Prefill > Manual Prefill.

Prefill the first 3 fields: Requester's Email, Name of who you need info about, and Information Needed. Click the button in the top right of Prefill to finish.

Now you see a list of Prefills. Use the drop-down next to the Prefill you just created to change 'Can edit' to 'Read Only' so the submitter can't edit the information you entered. Now copy the URL link and give it to whoever you need to provide the information.

You will receive an email on form submission instructing you to log in to JotForm to access their info securely.
Employee Name

First NameLast Name
Employee Email
example@example.com
Information Needed*

Full NameEmailHome PhoneHome AddressPercentage OwnershipTitleDate of BirthHeightWeightSexRaceEye ColorHair ColorDriver's License Number & StateDriver's License ScanSSN/TIN10 Year Work HistoryResume
Client Name

First NameLast Name
Client Email
example@example.com
Company Name
Legal Name of Entity
Full Legal Name*

PrefixFirst NameMiddle NameLast NameSuffix
Email*
example@example.com
Home Phone*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title*
Percentage of ownership*
Date of Birth*

MonthDayYear
Height*
Weight*
Sex*
Race*
Eye Color*
Hair Color*
Driver's License Number*
Driver's License State
Driver's License Scan*

Cancelof
10-Year Work History*

Cancelof
Resume*

Cancelof
Social Security Number (SSN) or Tax Identification Number (TIN)*
Example: 123-45-6789
Your Contact Information
Are completing this form for somebody else?*

YesNo
Contact Name

First NameLast Name
Contact Phone Number
Please enter a valid phone number.
Contact Email
example@example.com
Should be Empty:

Individual Sensitive Information Form

Employee Instructions

Your Contact Information