2. Active City of Green Bay Employees:
   Please provide the Human Resources Department with the most current contact information.
4. Today's Date*
   Today's Date
6. Employee First Name*
7. Employee Last Name*
8. Employee's Department*
10. Employee's last 4 digits of SSN*
    Please include the last 4 digits of employee's social security number for verification and security purposes.
12. New Address
14. City
15. State
16. Zip Code
18. New Home Phone Number
19. New Cell Phone Number
21. New Email
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field