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    Employee Status Change

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    The Employee Status Change form is provided for you by HR.com as a free service. The free hr templates and forms on this site are general in nature and not based on the laws of any specific state or other jurisdiction. Prior to using these policies or forms, we recommend that you consult with an attorney or other expert knowledgeable in the laws of the applicable jurisdiction and the specific intended use of those documents.


     

    EMPLOYEE STATUS CHANGE

     

    EMPLOYEE PROFILE

     

     

    Employee Name:

    Social Security #:

    Date:                                                  

    Date Effective:

     

    CLASSIFICATION CHANGES

     

     

    Change 

    Old Information                      

    New Information

    Transfer

    Title/Dept:

    Title/Dept:

    Promotion

    Title/Dept:

    Title/Dept:

    Demotion

    Title/Dept:

    Title/Dept:

    Title

    Title/Dept:

    Title/Dept:

    Shift

    Shift:

    Shift:

    Location

    Location:

    Location:

    Salary

    Salary:

    Salary:

    Status

    Status:

    Status:

    Merit Bonus

    Reason:

    Amount:

    Other change:

     

    Notice of COBRA rights?

    Date Provided:

    Election of COBRA?

    Start Date:

     

     

    ADDITIONAL COMPENSATION/BENEFITS INFORMATION

    Please list any changes in compensation and benefits:

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

     

    Please list any other changes, not listed above:

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

     

     

    VERIFICATION OF CHANGES

    __________________

    Manager Signature

     

    __________________

    Date

     

    __________________

    Approved By

     

    __________________

    Executive Signature

     

    __________________

    Date



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