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LaGuardia Community College

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LaGuardia Community College
CHANGE OF NAME AND/OR ADDRESS
OLD
NEW
TO BE COMPLETED BY PERSONNEL
Documentation provided:
REV 12/2019
INSTRUCTIONAL STAFF ADMINISTRATIVE STAFF NON-INSTRUCTIONAL STAFF
TITLE
Last 4 digits Soc.Sec.#
NAME
NAME
ADDRESS ADDRESS
PHONE NUMBER
PHONE NUMBER
FRINGE BENEFITS PAYROLL ADDRESS LIST INFORMATION TECHNOLOGY FILE ACADEMIC AFFAIRS
INITIAL
DATE
WAGEWORKS / TRANSIT
* Changes to Benefits includes: Health Plan & PSC only. Contact Pension, Welfare Fund & any additional supplemental plan directly to update.
DATE
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LaGuardia Community College

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Completed 26 July 2020

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