Human Resources by 8l661W6

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									UW-L Human Resources                                                                      Updated 7/4/2012
Student Payroll

                                             Human Resources
                                    Student Employee
                                           Address Change Form
                     ** Please complete this form ONLY if you are a student employee **

Today’s Date:

Legal Name (Please Print):

Person ID or Social Security Number:

NEW LEGAL ADDRESS (for W-2 purposes)

Effective Date

Street

City, State, Zip



Signature




Upon completion of this form, please bring it to:

Student Payroll
Human Resources
144 Graff Main Hall

                               FOR HUMAN RESOURCES USE ONLY:
                                         (Please initial when completed)

                               ____ Address changed on 3270 and SAS




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