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CHANGE OF EMPLOYEE STATUS

Date:

Employee name:
Employee number:
Department:
Social Security number:
Effective date of change(s):

Please make the following changes to the above employee's personnel records.

Job classification from To
Job title from To
Pay change from To
Shift change from To
Full-time/part-time change from To
Temporary/permanent change from To

Other changes (describe)

Submitted by:
Date:

Approved by:

Date

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For Up-To-Date Forms Covering Just About Every State & Situation plus Summaries of
Relevant Laws We STRONGLY SUGGEST Checking Out
'LLL's 25,000+ Premium Forms - Every Subject, Every State
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