Town of Burlington - Change of Address Form
This form is for Town of Burlington/Burlington Public Schools employees to update payroll, benefits, and your employee record with your new address.

In addition, if you have a name change, you will need to submit proof of legal change (such as a Social Security Card) before we can update your record.

Your full name *
Your answer
Birthdate *
used for verification purposes
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/
DD
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YYYY
Department *
Old Address
Street / City / State / Zip
Your answer
New Address
Street / City / State / Zip
Your answer
Old Phone Number
Your answer
New Phone Number
Your answer
Effective date of change *
If the change is immediate, enter today's date
MM
/
DD
/
YYYY
Submit
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