Florida 4046 Form in PDF
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The Florida 4046 form, officially known as the Address Change Form, serves a crucial role for employees of the School Board of Broward County. This form is specifically designed for new hires who are eligible for personnel information exemption and for former employees seeking to update their address after a job separation that exceeds 45 days. Current employees and those who have recently separated are encouraged to use the Employee Self-Service (ESS) system for address updates. The form requires essential information, including the employee's name, personnel number, and both permanent and alternate addresses, along with contact numbers. It is important to note that under Florida Statute 119.071, most personnel information is subject to public disclosure, but certain employees may qualify for exemptions based on their job responsibilities or family relationships. To take advantage of this exemption, eligible employees must complete a Personnel Information Exemptions Form and submit it to the Personnel Records Department. The completion of the Florida 4046 form is necessary for those wishing to maintain confidentiality, as it requires both an alternate address and a confidential address to ensure proper recording as a confidential employee. Without both addresses, the request for confidentiality cannot be fulfilled. The form concludes with a signature and date, and must be submitted to the Personnel Records Department to finalize the address change process.
Form Example
THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA
ADDRESS CHANGE FORM
This form is to be used by new hires eligible for personnel information exemption and by former employees requesting an address change more than 45 days after their job separation date. Current employees and recently separated employees must update their
address via Employee
EMPLOYEE NAME:PERSONNEL #:
PERMANENT (HOME)/ALTERNATE ADDRESS: This information may be released to the public under Florida Statute 119.071
PERMANENT ADDRESS:
CITY
STATE
ZIP CODE
HOME PHONE # (Include Area Code):
OTHER PHONE # (Include Area Code):
CONFIDENTIAL ADDRESS: Florida Public Records law (Florida Statute 119.071) requires government agencies to make available upon request for public inspection most written communications and records, including personnel information about employees except for Social Security number and other specific information. However, some employees are exempt from having selected personnel information disclosed due to their job responsibilities or family relationships. To be exempt from this disclosure, eligible employees must request this exemption and declare their status by completing and submitting a Personnel Information Exemptions Form to Personnel Records Department.
Only those employees falling into one of the identified categories on the Personnel Information Exemptions Form are eligible to have selected personnel information exempt from public release – if none of the categories apply to you, you are not eligible to
request this exemption.
After the personnel exemption is identified, the Confidential Address will be entered. You must provide BOTH an Alternate
Address (above) and a Confidential Address (below). If both addresses are not provided, you will not be recorded as a confidential employee.
CONFIDENTIAL ADDRESS: |
CITY |
STATE |
ZIP CODE |
|
|
|
|
CONFIDENTIAL PHONE # (Include Area Code): |
OTHER CONFIDENTIAL PHONE # (Include Area Code): |
||
|
|
|
|
EMPLOYEE SIGNATURE:
DATE:
Submit completed, signed form to the Personnel Records Department
Form #4046 (Rev 4/12) |
|
Personnel Records Department |
Address Change Form 0311 |
Document Breakdown
| Fact Name | Details |
|---|---|
| Form Purpose | The Florida 4046 form is designed for new hires and former employees to request an address change. |
| Eligibility Criteria | Only new hires eligible for personnel information exemption and former employees more than 45 days post-separation can use this form. |
| Current Employee Process | Current employees must update their address through the Employee Self-Service (ESS) portal, not this form. |
| Public Records Law | This form is governed by Florida Statute 119.071, which outlines public access to personnel information. |
| Confidential Address | Employees seeking confidentiality must provide both an alternate and a confidential address on the form. |
| Exemption Request | Eligible employees must complete a Personnel Information Exemptions Form to claim exemption from public disclosure. |
| Signature Requirement | The employee must sign and date the form before submission to ensure validity. |
| Submission Destination | Completed forms should be submitted to the Personnel Records Department for processing. |
| Revocation Date | The current version of the form was last revised in April 2012 (Rev 4/12). |
| Form Number | The official designation for this document is Form #4046. |
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