EMPLOYEE INFORMATION CHANGE FORM
Name _______________________________________________________________________________
Last First Middle
Social Security Number _________________________________________________________________
(If name changed due to marriage/divorce please provide copy of new driver’s license, marriage license, social security card)
Full Time employee Part Time Employee
Administration Faculty Adjunct Staff
Maintenance Part-time College Pay
Job Title:____________________________________________________________________________
Please check the box next to each item changed, only fill in information that has changed
Address _____________________________________________________________________________
Street Address City State Zip
Home Phone Number __________________________________________________________________
Area Code Number
Cell Phone Number ____________________________________________________________________
Area Code Number
Home E-Mail _________________________________________________________________________
IN CASE OF AN EMERGENCY, PLEASE NOTIFY:
Name ____________________________________ Relationship ____________________________
Address _____________________________________________________________________________
Street Address City State Zip
Telephone____________________________________________________________________________
Area Code Number
Telephone____________________________________________________________________________
Area Code Number
PLEASE CHECK IF YOU ARE CHANGING THE STATUS OF YOUR PAYCHECK DISTRIBUTION:
Mail my paycheck to the following address: _________________________________________________
___________________________________________________________________________________
I will pick up my paycheck in: Abilene Cisco.
Please Print,Sign and Return Completed Form to:
Cisco College
Attn: Human Resources
101 College Heights
Cisco TX 76437
Signature ____________________________ Date_______________
Human Resource Use Only:
Received________________
Entered_________________
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