"Payroll/Status Change Form"

ADVERTISEMENT
ADVERTISEMENT

Download "Payroll/Status Change Form"

Download PDF

Fill PDF online

Rate (4.4 / 5) 21 votes
Payroll/Status Change Form
 New Hire
 Change
 Separation
Employee Information
Effective Date of Change: ___________________ Employee/Payroll #: __________________
Employee Name: __________________________ Department: ________________________
Address: _________________________________ Date of Hire: ________________________
_________________________________________ Date of Birth: ________________________
Employee Status
 Exempt Non-Exempt
 Part-time
 Full-time
Hourly
Salary
Change(s) for Employee
Type
Previous
New
Comments/Reasons
New Hire Rate
n/a
New Hire Title
n/a
New Hire Supervisor
n/a
Rehire
Transfer
Reclassification
Merit Increase
$
$
% increase
Annual Increase
$
$
% increase
Promotion Increase
$
$
% increase
Promotion Title Change
Demotion Decrease
$
$
% decrease
Demotion Title Change
Leave of Absence
Supervisor Change
Separation
Other
Employee Signature: ____________________________________ Date:_____________
Supervisor Signature: _____________________________________ Date: _____________
(Incomplete forms may result in processing delays)
For Administration Use Only
Date Received: ___________
 Payroll Updated – Date Entered: ____________  File Updated – Date Entered: ___________
Payroll/Status Change Form
 New Hire
 Change
 Separation
Employee Information
Effective Date of Change: ___________________ Employee/Payroll #: __________________
Employee Name: __________________________ Department: ________________________
Address: _________________________________ Date of Hire: ________________________
_________________________________________ Date of Birth: ________________________
Employee Status
 Exempt Non-Exempt
 Part-time
 Full-time
Hourly
Salary
Change(s) for Employee
Type
Previous
New
Comments/Reasons
New Hire Rate
n/a
New Hire Title
n/a
New Hire Supervisor
n/a
Rehire
Transfer
Reclassification
Merit Increase
$
$
% increase
Annual Increase
$
$
% increase
Promotion Increase
$
$
% increase
Promotion Title Change
Demotion Decrease
$
$
% decrease
Demotion Title Change
Leave of Absence
Supervisor Change
Separation
Other
Employee Signature: ____________________________________ Date:_____________
Supervisor Signature: _____________________________________ Date: _____________
(Incomplete forms may result in processing delays)
For Administration Use Only
Date Received: ___________
 Payroll Updated – Date Entered: ____________  File Updated – Date Entered: ___________