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Coachella Valley Unified School District
Substitute Employee-Change of Personal Information Form
1/30/2023

Coachella Valley Unified School District
CHANGE OF PERSONAL INFORMATION

Change(s) Being Requested: *

Name

Telephone #: Work, Home and/or Cell

Address

Work Site

Emergency Contact Information

Other

Personal E-mail

Work E-mail

YOUR EMPLOYMENT STATUS:

I am a Certificated Employee

I am a Classified Employee (non-teaching position)

I am a Substitute/Temporary Employee (non-teaching position)

I am a Substitute Teacher

Old Name: *

Your current name if there is no name change

New Name:

If changing your name, an original signed W-4 form must be delivered to the Human Resources Department, as well as a copy of your Social Security card with the new name.

Social Security No.: *

W-4

Attached is a blank W-4 Form for your use. (Click on "W-4" icon) REMINDER: You must submit signed original W-4 to Human Resources Dept.

Old Home Address:

New Home Address:

Old Mailing Address:

Not required if same as home address

New Mailing Address:

Not required if same as home address

Old Work Phone:

Old Home Phone:

Old Cell:

New Work Phone:

New Home Phone:

New Cell:

Current E-mail:

Proposed New E-mail:

Old Work Site:

New Work Site:

OTHER:

OLD EMERGENCY CONTACT INFORMATION

Old Name:

Old Tel. No.:

Relationship:

Address:

NEW EMERGENCY CONTACT INFORMATION

New Name:

New Tel. No.:

Relationship:

Address:

CalSTRS Form

ATTN CERTIFICATED EMPLOYEES: Attached is a blank CalSTRS Change of Address form. (Click on "CalSTRS Form" icon) It is the employee's responsibility to complete and mail to CalSTRS. You can also update your address and email online using your myCalSTRS account at CalSTRS.com.

Effective Date of Change: *

______________________________________________________________________________________________
FOR OFFICE USE ONLY

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