Employee Status Change Form

ADVERTISEMENT
EMPLOYEE STATUS CHANGE FORM
EMPLOYEE NAME: ___________________________ ID#: ___________
PAY CHANGES:
Effective Date: _________ (must be the beginning of a pay period, mid-pay period changes not accepted)
Orig. Hire Date: __________Change Reason:___________________________
Orig. Pay Rate: ____________hourly to NEW pay rate:_____________ hourly
POSITION/JOB CHANGES:
Effective Date: ____________ (must be the beginning of a pay period, mid-pay period changes not accepted)
Change Reason: ______________________________________________________________________
PREVIOUS: Position Title: _______________________________ Location: ____________________
Total weekly hours ___________________
Exempt: ______ or Non-exempt: ______ (please check one)
_____RFT (over 35), _____PT 75 (30-34), _____PT 50 (20-29), _____ LPT (10-20), _____Per Diem
NEW: Position Title: _______________________________ Location: ____________________
____ RFT (over 35), _____ PT 75 (30-34), _____ PT 50 (20-29), _____ LPT (10-19), ____Per Diem
Total weekly hours ____________________
Exempt: ______ or Non-exempt: ______ (please check one)
New Supervisor ______________________ CFR CODE: For HR Use Only _________________
CaraSolva: For HR Use Only _________
TERMINATIONS:
Effective Date: ____________ Position Title: ______________________ Location: _____________________
Termination Reason: _________________________ Eligible for rehire?: ____________ (yes or no)
To Per Diem?: _______ (yes or no)
CaraSolva: For HR Use Only __________
ACCRUAL CODES: For Payroll USE ONLY
Previous accrual code: ______________ NEW accrual code: _______________
Pay Rule: Salary (70 hr): ____, Hourly: ____, Direct Care: ____, Other: ____________ (for special pay rules)
Entered into Kronos
___________________________
___________________________
___________ by: _____________
Supervisor Signature
Human Resources Signature
Date
on: _____________
Copy to Karen Doyle____ (please check)
EMPLOYEE STATUS CHANGE FORM
EMPLOYEE NAME: ___________________________ ID#: ___________
PAY CHANGES:
Effective Date: _________ (must be the beginning of a pay period, mid-pay period changes not accepted)
Orig. Hire Date: __________Change Reason:___________________________
Orig. Pay Rate: ____________hourly to NEW pay rate:_____________ hourly
POSITION/JOB CHANGES:
Effective Date: ____________ (must be the beginning of a pay period, mid-pay period changes not accepted)
Change Reason: ______________________________________________________________________
PREVIOUS: Position Title: _______________________________ Location: ____________________
Total weekly hours ___________________
Exempt: ______ or Non-exempt: ______ (please check one)
_____RFT (over 35), _____PT 75 (30-34), _____PT 50 (20-29), _____ LPT (10-20), _____Per Diem
NEW: Position Title: _______________________________ Location: ____________________
____ RFT (over 35), _____ PT 75 (30-34), _____ PT 50 (20-29), _____ LPT (10-19), ____Per Diem
Total weekly hours ____________________
Exempt: ______ or Non-exempt: ______ (please check one)
New Supervisor ______________________ CFR CODE: For HR Use Only _________________
CaraSolva: For HR Use Only _________
TERMINATIONS:
Effective Date: ____________ Position Title: ______________________ Location: _____________________
Termination Reason: _________________________ Eligible for rehire?: ____________ (yes or no)
To Per Diem?: _______ (yes or no)
CaraSolva: For HR Use Only __________
ACCRUAL CODES: For Payroll USE ONLY
Previous accrual code: ______________ NEW accrual code: _______________
Pay Rule: Salary (70 hr): ____, Hourly: ____, Direct Care: ____, Other: ____________ (for special pay rules)
Entered into Kronos
___________________________
___________________________
___________ by: _____________
Supervisor Signature
Human Resources Signature
Date
on: _____________
Copy to Karen Doyle____ (please check)

Download Employee Status Change Form

445 times
Rate
4.4(4.4 / 5) 22 votes
ADVERTISEMENT