"Employee Personal Information Changes Form - Sonora Union High School District"

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Sonora Union High School District
100 School Street, Sonora CA 95370 || Phone (209) 533-0423 x14 || Fax (209) 532-4513
EMPLOYEE PERSONAL INFORMATION CHANGES
If you’ve had a change of personal information in the past year, please complete the following:
PERSONAL INFORMATION
Date_______________________
Employee Name___________________________________________
Telephone Number _________________________
Mailing Address __________________________________________
Physical Address __________________________
________________________________________________________
_________________________________________
Other Changes__________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
EMERGENCY INFORMATION
Emergency Contact Name_____________________________________ Relationship to You_________________________
Emergency Contact Phone(s): Home Phone __________________________________
Cell Phone __________________________________
Work Phone __________________________________
Emergency Contact’s Address_______________________________________________________
_________________________________________________________
SPECIAL NOTE
If you have a change in marital status or change in number of dependents (i.e., “baby”), it may affect your health benefits. In
either situation, please call the District Payroll Office immediately at 533.8510, ext. 14. If you have any other questions,
feel free to contact the District Personnel Office at 533.8510, ext 12.
________________________________________ _____________________________________ ____________________
Printed Name
Employee’s Signature
Date
***Please return completed form to Attn. Susan Camp, District Personnel Office***
Routing Initials: _____Personnel
____Accounting
_____Payroll
Print
Submit
Revised 8/2013 DV
Sonora Union High School District
100 School Street, Sonora CA 95370 || Phone (209) 533-0423 x14 || Fax (209) 532-4513
EMPLOYEE PERSONAL INFORMATION CHANGES
If you’ve had a change of personal information in the past year, please complete the following:
PERSONAL INFORMATION
Date_______________________
Employee Name___________________________________________
Telephone Number _________________________
Mailing Address __________________________________________
Physical Address __________________________
________________________________________________________
_________________________________________
Other Changes__________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
EMERGENCY INFORMATION
Emergency Contact Name_____________________________________ Relationship to You_________________________
Emergency Contact Phone(s): Home Phone __________________________________
Cell Phone __________________________________
Work Phone __________________________________
Emergency Contact’s Address_______________________________________________________
_________________________________________________________
SPECIAL NOTE
If you have a change in marital status or change in number of dependents (i.e., “baby”), it may affect your health benefits. In
either situation, please call the District Payroll Office immediately at 533.8510, ext. 14. If you have any other questions,
feel free to contact the District Personnel Office at 533.8510, ext 12.
________________________________________ _____________________________________ ____________________
Printed Name
Employee’s Signature
Date
***Please return completed form to Attn. Susan Camp, District Personnel Office***
Routing Initials: _____Personnel
____Accounting
_____Payroll
Print
Submit
Revised 8/2013 DV