Employee Information Change Form



This form can only be used for address changes. name changes, and phone number changes for BOE employees only.  Please note this form is NOT for CITY employees (UAW, MAA, CUS). 

All name changes will need supporting documentation.  

Due to electronic signature regulations, once this form is submitted, the entry cannot be changed.  However, you may submit another form if this information changes. 


Forms and documentation must be submitted by noon on the Wednesday prior to payroll in order to go into effect that pay period.

Current Full Name *
This number is located on your paystub (top left next to Employee Name)
Date of Birth *
What change would you like to make? *

Name Change Acknowledgements/ Next Steps

Please note the following: 

  • The following systems will be updated to reflect this change:
    • Dayforce (HRIS/Payroll) 
    • Safeschools/Vector Training
    • PowerSchool
    • Frontline/AESOP
    • Protraxx
  • Changing your name with Human Resources/Payroll will now automatically change your City and Gmail email addresses.  IT will contact you directly to arrange the changes on your account.  
  • You will have access to your old email address for the remainder of the current school year for transitionary purposes (with limited exception - IT will reach out if that is not the case).
  • With the change in email address, your PowerSchool Username will be updated but your password will remain the same. 
  • You will receive a new badge with your updated name via interoffice mail in 5-7 business days.


For Certified Staff (required), please update the following with your new name: 

  • CT State Department of Education
  • To change your Last Name: Login to the Connecticut Educator Certification System (CECS). Under Profile, select Personal Info. Within the User Profile Tab, make any changes to your last name and click Update.
  • To change your First Name: E-mail Teacher.Cert@CT.gov to update your name. Be sure to include your EIN in your email whenever emailing the CSDE



New Full Name*
No File Chosen
File uploads may not work on some mobile devices.
ie. marriage certificates, court documents, updated identification cards, etc
Current Address*
New Address *

NEXT STEPS 

For Certified Employees only: Update your address with the Connecticut State Department of Education.  Login to the Connecticut Educator Certification System (CECS). Under Profile, select Personal Info. Within the Contact Information Tab, make any changes to your contact information and click Update.


Which phone number should be used for School Messenger purposes (if applicable) (eg. school delay alerts)*
Use your mouse or finger to draw your signature above

Human Resources Processing

Data Entry Completed? *
If unable to make change, select reason
Date/Time
:  

Benefits Processing

If employee does not have benefits, please check the box below.
Changes Made in...*
Date/Time
:  

Authorization and Confirmation of Coverage

Use your mouse or finger to draw your signature above
Date/Time
:  
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