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Coachella Valley Unified School District
Substitute Employe-Change of Personal Information Form
10/28/2021


Coachella Valley Unified School District
CHANGE OF PERSONAL INFORMATION

.
Change(s) Being Requested: *
Name  
Address  
Telphone #: Work, Home and/or Cell  
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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