"Employee Status Change Form"

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EMPLOYEE STATUS CHANGE
Includes any change of an employee’s status including termination/resignation/retirement.
Today’s Date: ______________ Employee Name: _______________________________________________
Current Position: __________________________________________________________________________
Job Title Change
From: _________________ To: ____________________ Effective: _______________
Job Class Change
From: _________________ To: ____________________ Effective: _______________
Building Change
From: _________________ To: ____________________ Effective: _______________
FTE Change
From: _________________ To: ____________________ Effective: _______________
Grade Change
From: _________________ To: ____________________ Effective: _______________
Hours Change
From: _________________ To: ____________________ Effective: _______________
Salary Change
From: _________________ To: ____________________ Effective: _______________
Step Change
From: _________________ To: ____________________ Effective: _______________
Additional duties, position and explanation of change:
______________________________________________________________________________________________
______________________________________________________________________________________________
Resignation of Position* (still employed) Effective: _______________________
*This does not require a letter/notice, but should be explained in comment section below.
Resignation of Employment (no longer employed district wide)
Effective date: ____________________ Letter/notice of termination attached (preferred)
*If a letter is not provided, please explain in comment section below.
Termination in Probationary Period (Consult with HR prior to termination)
Termination effective date: _______________ Hire date: ____________
Retirement effective date: _________________________
Comments: ___________________________________________________________________________________
______________________________________________________________________________________________
Signature of Hiring Authority ___________________________________________________________________
Approval/Signature of Superintendent ________________________________HR Director Approval: _______
Distributed copies: Payroll Clerks, District Secretary & Benefits
Initials: ______________
Date:
______________
If termination of employment, HR will inactivate Aesop information
Initials
_____________
Date:
______________
If termination or building change, HR will distribute to IT Tech
Initials
_____________
Date:
_______________
12‐01‐15 
EMPLOYEE STATUS CHANGE
Includes any change of an employee’s status including termination/resignation/retirement.
Today’s Date: ______________ Employee Name: _______________________________________________
Current Position: __________________________________________________________________________
Job Title Change
From: _________________ To: ____________________ Effective: _______________
Job Class Change
From: _________________ To: ____________________ Effective: _______________
Building Change
From: _________________ To: ____________________ Effective: _______________
FTE Change
From: _________________ To: ____________________ Effective: _______________
Grade Change
From: _________________ To: ____________________ Effective: _______________
Hours Change
From: _________________ To: ____________________ Effective: _______________
Salary Change
From: _________________ To: ____________________ Effective: _______________
Step Change
From: _________________ To: ____________________ Effective: _______________
Additional duties, position and explanation of change:
______________________________________________________________________________________________
______________________________________________________________________________________________
Resignation of Position* (still employed) Effective: _______________________
*This does not require a letter/notice, but should be explained in comment section below.
Resignation of Employment (no longer employed district wide)
Effective date: ____________________ Letter/notice of termination attached (preferred)
*If a letter is not provided, please explain in comment section below.
Termination in Probationary Period (Consult with HR prior to termination)
Termination effective date: _______________ Hire date: ____________
Retirement effective date: _________________________
Comments: ___________________________________________________________________________________
______________________________________________________________________________________________
Signature of Hiring Authority ___________________________________________________________________
Approval/Signature of Superintendent ________________________________HR Director Approval: _______
Distributed copies: Payroll Clerks, District Secretary & Benefits
Initials: ______________
Date:
______________
If termination of employment, HR will inactivate Aesop information
Initials
_____________
Date:
______________
If termination or building change, HR will distribute to IT Tech
Initials
_____________
Date:
_______________
12‐01‐15 

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