Personal Information Change Form

Timer

--:--

* = required field

Some content may be updated based on selection

Personal Information Change Form

Please complete this form to notify Human Resources of the update required.

Current Information

Your Full Name (as we currently know it to be):

Department Name:

Employee Type:

Your Banner/OneCard ID # (begins w/@):

Your Payroll ID (6 numbers):

What is the effective date of your demographic change?:

Do you need to submit a legal name change?:

Name Change

Please submit a copy of your social security card to Payroll for any legal name changes.

Legal First Name (must match social security card):

Legal Middle Name or Initial (must match social security card):

Legal Last Name (must match social security card):

Do you need to submit a change of address??:

Residential Address Change

New Street Address:

Apt or Building Number:

City:

State:

Zip Code:

Country (If other than USA):

Is your mailing address different than the above address?:

Mailing Address Change

New Mailing Address:

City:

State:

Zip Code:

Country (If other than USA):

Do you need to submit another demographic change? (Example: Telephone number, email, birthdate, social security number etc.):

Other Change

Home Telephone:

Cell Phone:

Personal Email:

Birthdate (provide identification in Payroll):

By entering the last 4 digits of my social security number below, I am verifying that these demographic changes were made by me. I further acknowledge that I will bring my social security to payroll for verification of any legal name change.

Please wait for files to finish uploading