SF-023 Personnel Change Request

Service Provider Notification of Personnel Change. Complete this form to notify FedEx Ground of an employee assignment change. The completed, signed document will be emailed to you within 24 hours.

Form Information

Service Provider Entity *

Business ID

—

Authorized Officer

Josh Stenson

Date *

Station Name/Number *

Business Contact Name *

Employee(s) to be Removed from Assignment

Enter up to 3 employees. At least one is required.

Employee 1 Name *

FedEx Vendor ID

Reason for Change

Service Provider Employment Separation

The employee's employment has been separated. Note: If a service provider terminates an employee, the DOT file may remain active.

No Longer Meets Agreement Terms

The employee no longer meets the terms of the Agreement to be assigned to provide Services. Attach any supporting documentation.

Where to Send the Completed Form

Once Josh signs, the completed SF-023 will be emailed directly to the address you provide below.

Your Name *

Email Address *

By submitting this form, you authorize King Capital Transport to file the SF-023 with FedEx Ground. This form will be signed by Josh Stenson (Authorized Officer) and returned to you via email.