Note: This form will submit directly to Human Resources.

Central Florida Community College
Personnel Info Change Form

Complete all entries in this section.

Name:	SS#:
Department/Division:
E-Mail address:

Complete only changes in this section.

Please be advised of the following changes:

NAME:

From:

To:

(If legal name changes, please forward a copy of new social security card and drivers license). For legal reasons, name will not be changed without SS proof - IRS Rules

ADDRESS:

Street Address:

Mailing Address:

City, State:

Zip Code:

PHONE:

New Phone:

Do you have (check applicable boxes) :

Blue Cross/Blue Shield

Florida Retirement*

Comp Benefits Corp Dental (please submit this form)

* Name change REQUIRES a new Beneficiary Designation Form which reflects correct name. Call Human Resources for a form.

OTHER:

Central Florida Community College Personnel Info Change Form

Central Florida Community College
Personnel Info Change Form