1-866-476-9008 Solutions@TELStaffing.com

Data Change Form

Please check the box and fill out related information for the data change you need to make. You can leave all other fields blank (unless noted as required).

"*" indicates required fields

MM slash DD slash YYYY
Employee Name*

Payroll Changes

MM slash DD slash YYYY
Pay Frequency
Workers Comp Code
Title

Other Changes

Address
Address
If this change will affect your state withholding status, please contact TEL Staffing & HR Payroll Department at 850.476.9008.
Telephone Number
Name
Name
Must provide legal documentation
Stop Direct Deposit
Financial Institution
Account Info
Other
Please explain in detail.

By typing your name on any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.
MM slash DD slash YYYY

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