Fillable Personal-Data ALVIN COMMUNITY COLLEGE

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Personal-Data ALVIN COMMUNITY COLLEGE

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ALVIN COMMUNITY COLLEGE
PERSONAL DATA
New Hires: Please complete the entire form and return to HR
Current Employees / Retirees: Use for any changes in name, address, phone number(s), and E-Mail addresses.
Request for name change requires a copy of the social security card with the new name.
SECTION I TYPE OF TRANSACTION
NEW HIRE
NAME CHANGE
ADDRESS CHANGE
PHONE CHANGE
E-MAIL
SECTION II EMPLOYEE / RETIREE INFORMATION (PLEASE PRINT OR TYPE)
AUTHORIZATION DATE:
(Last)
(First)
(M.I.)
DEPARTMENT:
SECTION III ADDRESS / PHONE / E-MAIL INFORMATION
MAILING ADDRESS:
(Street or P.O. Box)
(City)*
(State)*
(Zip)
HOME PHONE:
ALT PHONE/PAGER:
WORK PHONE:
CELL PHONE:
E-MAIL:
SECTION IV EMERGENCY CONTACT INFORMATION
NAME:
RELATION:
PHONE:
I authorize this personal information for entry into the payroll system. I understand that this may also be used to update my personal
information in the group insurance program and the TRS system if applicable.
PRIVACY:
Home / Mailing Address, Telephone Number, Emergency Contact Information, and Information Regarding Family Members can be considered
private information in the event that Alvin Community College receives a request under the Public Information Act. Please mark your
preference below. Your social security number is confidential.
PUBLIC
My home address, phone number, emergency contact information, and information regarding family members may be
released.
PRIVATE
I request that my home address, phone number, emergency contact information and information regarding family members
not be released. This request is being made in accordance with Tex. Gov’t Code Chp.552 (Texas Public Information Act).
(R 02/05/15)
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Personal-Data ALVIN COMMUNITY COLLEGE

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Completed 15 November 2019

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