Fridley Public Schools - Name, Address or Telephone Number Change
Name, Address or Telephone Number Change
Organization:
Fridley Public Schools
Assigned To:
Public User
Show History
Name, Address or Telephone Number Change
Please fill out this form if your name, address or telephone number changes.
Please note: Technology, payroll, and your school will be informed of the change. (if you provide your building/program secretary's email address below).
Name changes require legal documentation
. Please present documentation in person to Human Resources in the district office. Examples of acceptable documentation are: updated driver's license or social security card, official marriage certificate, divorce decree. Name Changes also
require
that you send a signed W-4 form to Payroll through the interoffice mail. W-4 forms are available on the Fridley School District website under Employment/Employee Resources.
Reminder to Teachers:
You are also
required
to change your name on your teaching license at MDE.
You must also change your demographic information with Plansource (https://benefits.plansource.com/logon) our insurance administrator. If you have flex accounts or a VEBA, you also need to change your address with Wex at https://www.wexinc.com/
NAME (First and Last)
NAME (First and Last) required
BUILDING:
DISTRICT OFFICE
FRIDLEY COMMUNITY CENTER
FRIDLEY HIGH SCHOOL
FRIDLEY MIDDLE SCHOOL
ALC-HS
ALC-MS
ECSE
HAYES ELEMENTARY
RL STEVENSON ELEMENTARY
TRANSITION
BUILDING: required
POSITION:
POSITION: required
Your BUILDING/PROGRAM SECRETARY'S email (not your email)
Your BUILDING/PROGRAM SECRETARY'S email (not your email) required
EMPLOYEE NAME CHANGE:
NEW NAME (Include First and Last Name):
EFFECTIVE DATE OF NAME CHANGE:
EMPLOYEE ADDRESS OR PHONE CHANGE
NEW ADDRESS (Include House Number, Street Address, City, State & Zip)
NEW PHONE NUMBER (Include area code)
EFFECTIVE DATE OF ADDRESS/PHONE CHANGE:
NEW EMAIL ADDRESS:
COMMENTS: (use this box to let us know if there are other changes to your demographic information needed in skyward, i.e. update an emergency contact, delete a phone number, add another email address, etc.)
EMPLOYEE SIGNATURE
Signing
Signature is required
By typing in your name (your “eSignature”), you accept and consent to be legally bound by this document’s statements, terms and conditions as if this document was signed by you in writing with pen on paper. You agree that no third party or other means of verification is necessary to validate your eSignature and that the lack of such third party or other means of verification will not in any way affect the enforceability of this document.
For HR Use: Update Teachers on Call with NAME CHANGES
Yes
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History
Step:
Someone fills out the form
Sent To: Public User, On:
12/21/2024 11:08:52 AM Central Standard Time
