Online Form - Change of Details Form

Current Employee Details

Surname*

Given Name(s)*

Employee Number

Business Unit*

Change of Details (please select applicable)

Please select applicable from below*

Change of Address (Section A)Change of Contact Details (Section B)Change of Banking Details (Section C)Change of Marital Status (Section D)Change of Name (Section E)Change of Emergency Contacts (Section F)

Section A: Change of Address

New Residential Address

New Postal Address

Section B: Change of Contact Details

Home Number

Mobile Number

Email Address

Section C: Change of Bank Details

Bank

Branch

BSB Number

Account Number

Account Name

Please list any other account details and amounts for where you would like your salary to be paid (include Account Name, BSB, Account Number, Amount)

Section D: Change of Marital Status

Please indicate your previous marital status

Please indicate your new marital status

Section E: Change of Name

Please enter your previous name (surname and given name)

Please enter your new name (surname and given name)

Please enter new title (Mr/Mrs/Miss/Ms/Dr)

Please indicate reason for change (employee is required to provide documents to support came change)

Please upload any documentation to support your name change

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Section F: Change of Emergency Contact Details

Name

Relationship

Home Number

Mobile Number

Section G: Citizenship Declaration

Are you an Australian Citizen?*

YesNo

If no, do you have a working Visa?

If you have a working Visa, what is its expiry date?

Additional Superannuation (if Applicable)

I hereby authorise the Town of Port Hedland to deduct from my salary the following additional superannuation contribution each pay period (fortnight) that will be contributed towards my nominated superannuation fund.

Please select the superannuation percentage

How is the deduction to be made?

Communications

If you do not have a ToPH email address, would you like to receive 'All Staff' notifications including Friday Facts sent to your personal email address?

YesNo

Employee Signature

Name*

Position*

Signature (first initial and last name)*

Date*