Staff Changes Form Full name: Location: Job title: Personal number (8 digits): Amendment or addition Date Record change here effective Change of address Change of telephone number Married - surname and date to be Surname: verified by copy of marriage certificate Divorced - surname and date to Surname: be verified by copy of Decree Absolute Change of contracted hours Change of Reason Band New job Reason Salary Qualification / proficiency Qualification title obtained Registration number Incremental date change Acting up - end date required. If Job title not known a max of 3 months will Date ending be applied Change to unsocial hours Current New Percentage Percentage On Call allowance Current New Percentage Percentage Change of work location From Reason To Extension of fixed term contract Duration of or secondment (delete as extension appropriate) Any change ie: Maternity / paternity leave applic form & MATB1 required Unpaid C1/D1 loan For changes relating to personal information, hours, job titles, unsocial hours, on call, location change or acting up arrangements please send to For changes relating to maternity, paternity or unpaid leave please send to Please note there are separate forms for retirements or leavers available via the intranet Approved by: Date: Input on ESR by: Date:
Staff Changes Form Full name: Location: Job title: Personal number (8 digits): Amendment or addition Date effective Record change here Change of address Change of telephone number Married - surname and date to be verified by copy of marriage certificate Surname: Divorced - surname and date to be verified by copy of Decree Absolute Surname: Change of contracted hours Change of Band Reason New job Salary Reason Qualification / proficiency obtained Qualification title Registration number Incremental date change Acting up - end date required. If not known a max of 3 months will be applied Job title Date ending Change to unsocial hours Current Percentage New Percentage On Call allowance Current Percentage New Percentage Change of work location From To Reason Extension of fixed term contract or secondment (delete as appropriate) Duration of extension Any change ie: Maternity / paternity leave applic form & MATB1 required Unpaid C1/D1 loan For changes relating to personal information, hours, job titles, unsocial hours, on call, location change or acting up arrangements please send to For changes relating to maternity, paternity or unpaid leave please send to Please note there are separate forms for retirements or leavers available via the intranet Approved by: Date: Input on ESR by: Date: