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WAYNEPUBLICSCHOOLDISTRICT

EMPLOYEECHANGEOFINFORMATIONFORM

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PleasecompletethisformandreturnittoHumanResources.

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TypeofChange:  NameChangeOnly

  ChangeofAddressOnly

  ChangeofBothName&Address

  ChangeofTelephone/CellPhoneNumber(s)

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EffectiveDateofChange:____________________________

PLEASEPRINT

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CurrentName:_________________________________________________________

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ChangeNameto:_________________________________________________________

Check:Married ReturntoMaiden

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CurrentAddress:_____________________________________________________________

StreetTown  State Zip

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ChangeAddressto:______________________________________________________

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StreetTown State Zip

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NewTelephoneNumber:_____________________________

NewCellPhoneNumber:_____________________________

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**PLEASENOTETHATTHISFORMWILLBEFORWARDEDTOTHEAPPROPRIATEOFFICES;(ie:AESOP;PAYROLL;

BENEFITS;TECHNOLOGY;WEAUNION)

PAYROLLWILLNEEDANEWW‐4SIGNEDIFCHANGINGNAMEORDEPENDANTS(formonstaffwebsite)

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