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Back to Forms for 'Employee Management'.


EMPLOYEE STATUS CHANGE

EMPLOYEE STATUS CHANGE

 

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 ______________

 

 

Approvals:

 

Department Manager _________________________   Date __________________

 

Personnel Manager ___________________________   Date __________________

 

Original to Department Manager, copy to Personnel File.

 



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