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- "Change of Employee's Information Form" - Arkansas
"Change of Employee's Information Form" - Arkansas
Change of Employee's Information Form is a legal document that was released by the Arkansas State Police - a government authority operating within Arkansas.
Form Details:
- Released on May 1, 2019;
- The latest edition currently provided by the Arkansas State Police;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas State Police.
!["Change of Employee's Information Form" - Arkansas](https://data.templateroller.com/pdf_docs_html/2115/21153/2115344/page_1_thumb.png ""Change of Employee's Information Form" - Arkansas")
1Effective Date
5-2019
CHANGE OF EMPLOYEE’S
INFORMATION FORM
NOTICE: Information contained on this form is considered a public record and may be released under the
Freedom of Information Act. Under penalty of A.C.A. § 5-53-103, knowingly giving a false statement or
submitting a false document constitutes a Class A Misdemeanor.
(PREVIOUS) NAME OF CREDENTIALED EMPLOYEE ___________________________ ____ CREDENTIAL #________
THIS IS AN OFFICIAL NOTIFICATION TO THE DEPARTMENT OF THE ARKANSAS STATE POLICE THAT THE
FOLLOWING INFORMATION HAS CHANGED (select any changes that are applicable):
(
NEW) EMPLOYEE NAME (NOTE: Proper court documentation which created the change must be
attached to this form)
______________________________________________________
NEW MAILING ADDRESS
_______________________________________________________
_______________________________________________________
_______________________________________________________
NEW PHONE NUMBER
(________) _____________________________
NEW EMAIL ADDRESS
_______________________________________
I hereby certify to the Department of the Arkansas State Police that the above information is true and correct.
OWNER/MANAGER SIGNATURE ___________________________________________________ DATE_________________
NOTICE: A licensee or manager shall notify the Director of the Department of Arkansas State Police within
fourteen (14) days after a change in the credentialed person’s name, address, telephone number, or email
address.
Page 1 of 1
Effective Date
5-2019
CHANGE OF EMPLOYEE’S
INFORMATION FORM
NOTICE: Information contained on this form is considered a public record and may be released under the
Freedom of Information Act. Under penalty of A.C.A. § 5-53-103, knowingly giving a false statement or
submitting a false document constitutes a Class A Misdemeanor.
(PREVIOUS) NAME OF CREDENTIALED EMPLOYEE ___________________________ ____ CREDENTIAL #________
THIS IS AN OFFICIAL NOTIFICATION TO THE DEPARTMENT OF THE ARKANSAS STATE POLICE THAT THE
FOLLOWING INFORMATION HAS CHANGED (select any changes that are applicable):
(
NEW) EMPLOYEE NAME (NOTE: Proper court documentation which created the change must be
attached to this form)
______________________________________________________
NEW MAILING ADDRESS
_______________________________________________________
_______________________________________________________
_______________________________________________________
NEW PHONE NUMBER
(________) _____________________________
NEW EMAIL ADDRESS
_______________________________________
I hereby certify to the Department of the Arkansas State Police that the above information is true and correct.
OWNER/MANAGER SIGNATURE ___________________________________________________ DATE_________________
NOTICE: A licensee or manager shall notify the Director of the Department of Arkansas State Police within
fourteen (14) days after a change in the credentialed person’s name, address, telephone number, or email
address.
Page 1 of 1
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