Fillable MVCC ONEIDA COUNTY CHANGE OF INFORMATION FORM

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MVCC ONEIDA COUNTY CHANGE OF INFORMATION FORM

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ONEIDA COUNTY
CHANGE OF INFORMATION FORM
Return to: Oneida County Department of Personnel
800 Park Avenue Utica, New York 13501
Phone: (315) 798-5726 Fax: (315) 798-6490
E-mail: personnel @ocgov.net Web Site: www.ocgov.net
Social Security Number E-mail Address
Current Name Previous Name (if applicable)
Permanent Residence Address Mailing Address (if different)
City State Zip Code City State Zip Code
( ) ( )( )
Home Phone Number Cell Phone Number Work Phone
The following information is based on your permanent residence and may be used for residency preference on
certifications. Any incomplete or incorrect information may result in not being included on such certification.
School District of your permanent residence:
City or Village of your permanent residence:
Town of your permanent residence:
County of your permanent residence:
Affirmation and Signature: I affirm that the statements made on this form are true under penalties of perjury.
Date: Signature:
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MVCC ONEIDA COUNTY CHANGE OF INFORMATION FORM

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Completed 21 December 2019

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