Print this Employee Demographics Change Form                    Giles County Public Schools

151 School Road

Pearisburg, VA  24134

Employee Number                                                 

School:                                                                   

First Name:                                                                                 M                                                   Last:                                                                     

 

 

Please check Applicable Boxes

5

Change My Name:

                                                                                                                                                 

First Name                                           Middle                                        Last Name

 

Please Complete:  Health Insurance Personal Data Change Form

5

Change My Address:

                                                                                                                                                 

Street                                                   

 

                                                                                                                                                 

City                                                                                          State,  Zip

 

Please Complete:  Health Insurance Personal Data Change Form

5

Change My Phone #s:

(__________) ______________________________ (land line)


(__________) ______________________________ (cell)

 

Please Complete:  Health Insurance Personal Data Change Form

5

Change My Email Name:

Circle One:                  Immediately                 End of School Year

5

Change My IM Name:

Circle One:                  Immediately                 End of School Year

5

Change My PowerSchool Name:

Circle One:                  Immediately                 End of School Year

5

Change My Federal/State Tax Status:

Federal W-4 Form             Virginia W-4 Form             WV W-4 Form

5

Change My Direct Deposit Account:

Direct Deposit Form

5

Change My Virginia Retirement Beneficiary:

VRS Plans 1 or 2 Beneficiary              VRS Hybrid Plan Beneficiary

 

 

 

Employee Signature                                                                                                                                            Date:                                         

Please send this form and all attachments (if applicable) to the School Board Office Payroll Office.