TEANECK BOARD OF EDUCATON Human Resource Management

Personnel Record Information Change Report

HRM           A/C Payable Payroll     …..

NAME (Print):	           School/Dept:	

EFFECTIVE DATE:	

All personnel are required to notify their principal and Human Resource Management (HRM) of additions to or changes in personal information affecting school personnel and payroll records within fifteen (15) calendar days of the change by completion of this form and forwarding it to the principal.

The principal will initial receipt of this form, make a copy for payroll and HRM and forward copies to appropriate offices.

Check the applicable type of information change and supply the required information in the space provided. PLEASE PRINT.

NAME CHANGE:

New Name:

(Last)	(First)	(Middle)

Former Name:	

(Last)	(First)	(Middle)

ADDRESS CHANGE:

(New Address):	

(Street)

(City)

TELEPHONE NUMBER CHANGE: (New Telephone Number)

(State)

(Area Code)

(Zip)

(Number)

(Signature: EMPLOYEE)

(Signature: PRINCIPAL)

“COMMITMENT TO EXCELLENCE”