Payroll/status Change Form - Gw Human Resources
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1Payroll/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: ___________
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Parent category: Business