Integrity | Name Change

Employee Name Change
The information below will be used to verify your identify before any changes are made to your employee record.
Company Name*
Employee Number or Last Four of Social Security Number (SSN)*
Date of Birth*

MonthDayYear
Date
Original Employee Name*

First NameMiddle NameLast Name
New Legal Employee Name

First NameMiddle NameLast Name
Please download the IRS Fom W-4 and complete it with the new legal name.

https://www.irs.gov/pub/irs-pdf/fw4.pdf
Please upload supporting documentation of new W-4 form.*

Cancelof
Please upload supporting documentation of a copy of your driver's license, social security card, or court document to effect the change.*

Cancelof
Signature*

Clear
Should be Empty:

Employee Name Change