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Change Request Form www.calchoice.com 1 Employee Information Please print using black or blue ink EMPLOYEES: COMPLETE THIS FORM ONLY IF YOU ARE AN ACTIVE CALIFORNIACHOICE MEMBER WHO WANTS TO UPDATE
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How to fill out employees complete this form:

01
Start by carefully reading the instructions on the form. Make sure you understand what information is required and the format in which it should be provided.
02
Begin by filling in the employee's personal details such as their full name, address, contact information, and social security number.
03
Provide information about the employee's position within the company, including their job title, department, and supervisor's name.
04
Fill in details regarding the employee's employment status, such as whether they are full-time, part-time, or temporary, and their start date.
05
If applicable, include information about the employee's compensation package, including their salary or hourly rate, any bonuses or incentives, and details about benefits such as health insurance or retirement plans.
06
Next, provide any necessary information regarding the employee's tax withholding, such as their federal and state tax exemptions.
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If the form requires it, include information about the employee's dependents or beneficiaries, such as their spouse or children, and any insurance coverage they may have.
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Finally, review the completed form for accuracy and ensure that all required fields have been filled in correctly. Make any necessary corrections before submitting it.

Who needs employees to complete this form:

01
Employers and human resource departments require employees to complete this form as it is essential for maintaining accurate and up-to-date records of employees within the company.
02
Government agencies and regulatory bodies may also require these forms to be completed for compliance purposes and to ensure accurate reporting of employee information.
03
The employee themselves may need to complete this form in order to provide necessary information for payroll processing, benefits enrollment, and tax purposes.

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