New Hire/Re-Hire/Personnel Change - Denver Public Schools
Denver Public Schools
Department of Payroll & Business Services
Employee Information Change Form
Current Name on File
|*Last Name: |*First Name: |Middle Name: |
|*Employee #: |*School/Department: |Job Title: |
Action Type: Check all that apply.*
|Employee Action | | | |
| Name Change | Address/Phone Change | Resignation | Salary Advance |
|ProComp/TIR Request for Increase Upon |ProComp Advanced License |ProComp License Renewal |ProComp Advanced Degree |
|Completion of Program | | | |
New Name Change
(Must attach a copy of social security card with new name)
|*Last Name: |*First Name: |Middle Name: |
Address/Phone Change
|*Street: |*City: |
|*State: |*Zip Code: |*Home Telephone ( ) |
|*Effective Date (See Note Below): |
***NOTE: Effective Date must be current or future – Address changes cannot be back dated
Salary – Request for Salary Advance, Advanced License or Advanced Degree for ProComp (Licensed Employees)
(Must attach official transcripts or copy of advanced license with expiration date)
|*Degree received, hours completed, or credits in education earned since last salary increased: |
| |
|Title of License and Authorizing Agency: |
|**Effective Date |**Reason |
|**Schedule |**Pay Grade |** Pay Step |** Pay Rate |
Resignation
|*Resignation Date : *(Please indicate actual last day): |
|*Reason: |
| |
| |
|** Reason 1 |**Reason 2 |** Status Code |
* *
Employee Signature Date
* EMPLOYEE COMPLETE APPLICABLE ASTERISKED (*) SECTIONS, SIGN & DATE FORM
** FOR DEPARTMENT USE ONLY
EMAIL HR_PACEFORMS@ MAIL HR CONNECT, 900 GRANT STREET, ROOM 105, DENVER, CO 80203
FAX 720-423-2450 PHONE 720-423-3900
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