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Back to Forms for 'Employee Management'.




Name __________________________


Employer I.D. # __________________________


Department __________________________


Effective Date ________________


Wage/Salary/Title Change:


                    Title                        Grade                 Pay Rate           Increase %


Present       ________________      ___________      ___________      _________


Proposed   ________________      ___________       ___________      _________


Type of Change: (check appropriate type)


[  ] New Hire      [  ] Voluntary Resignation      [  ] Promotion      [  ] Leave of Absence


[  ] Sick Leave      [  ] Transfer      [  ] Return from Absence      [  ] Termination


[  ] Layoff      [  ] Disability - Non-Work      [  ] Disability - Work



If leave of absence, state duration - From ___________ To ___________


Comments and reasons for change: _______________________________________ ___________________________________________________________________ ___________________________________________________________________ __________________________________________________________________.



Submitted by:


Supervisor _____________________   Title ___________   Date ______________





Department Manager _________________________   Date __________________


Personnel Manager ___________________________   Date __________________


Original to Department Manager, copy to Personnel File.


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