Change of Personal Information

(address, telephone, hours, shift, dept.)

Pay Period Ending:_________

Employee:________________________________Employee#____________

Departments:

Production Management Fixture Assembly Building Maintenance

Shop Assembly Die Cutting Digital Imaging

Light Jet Etching Fabrication Shop

Receiving Graphic Assembly Installation

Painting Shop Cutting Packing

Screen Printing Accounting Information Systems

Sales Department Foreign Sales Sales Support

Customer Service Project Administration Design

Production Design

Old Address:_____________________________________________________________

Old Telephone#___________________________________________________________

New Address:____________________________________________________________

New Telephone#___________________________________________________________

Change in Hours – or- Shift From Hrs.________________ To Hrs.______________

From Shift________________To Shift______________

Change in Department: From Dept.________________To: Dept.______________

Explanation/Notes: ___________________________________________________

__________________________________________________

Completed By Supervisor Only!!!!

Supervisor’s Signature_________________________________Date:_________________

VGS Vacation, Holiday, Sick

accounting

2006-03-16

Mehrbod

Visual Graphic Systems, Inc.