Change of Information Form

 

Please print clearly and return to Human Resources, Shuster Hall, Room 230 

 

 

Name: 
(text) 




Title: 
(text) 
Date: 
(text) 




CUNY FIRST Employee ID: 
(text) 


(Contact H.R. if you are unsure of your Employee ID) 

 

Department: 
(text) 




Department Extension: 
(text) 
or Telephone: 
(text) 




*All changes will require documentation to be presented before they can be updated 
in our systems. 

Select and Fill out the changes:
(text) 


 

 
Name Change: 
(text) 




_____ 
(text) 
Address Change: 
(text) 




City, State, Zipcode 
(text) 


_____ 
(text) 
Telephone Change 
(text) 




 _____ 
(text) 
Marital Status Change: 
(text) 


 

 
(text) 
Degree Change: 
(text) 




 _____ 
(text) 
Other: 
(text) 






Completed by Human Resources on: 
(text) 
: ________________________________
(text) 






 to Central Payroll on: 
(text) 
(text)